PA Auditor: 68% of Tested EMS-Fund Spending Went Unverified
Summary
Pennsylvania's Department of the Auditor General audited how the state Department of Health oversees the Emergency Medical Services Operating Fund, which distributed $37.9 million to the EMS system and the Head Injury Program between July 2021 and June 2024. Of a $5.1 million sample of payments the auditor tested, DOH could not verify that 68% -- $3.4 million across 42 payments -- was spent for allowable purposes, the same lack of internal controls five straight audits have found since 2010. DOH says a fix is coming: a financial manager the department was approved to hire didn't start until June 30, 2025, and regional-council compliance staff couldn't be filled until fiscal year 2024-25 -- both positions arriving after the audit window they were meant to control had already closed.
What the fund pays for
The Emergency Medical Services Operating Fund (EMSOF) is filled mostly by a $20 fine on moving traffic violations and a $50 fee charged to drivers admitted to the state's DUI diversion program⧉. By law, 75% of that money goes to EMS agencies, regional councils, and the state advisory board; the remaining 25% funds the Head Injury Program⧉ for trauma victims. Over the three-year audit period, DOH distributed $37.9 million from the fund⧉ -- $29.3 million to the EMS side⧉ and $8.6 million to the Head Injury Program⧉, where auditors found no weaknesses at all.
View data as table
| FY2022 | 14,534,150 | Year ended June 30, 2022 |
|---|---|---|
| FY2023 | 15,143,151 | Year ended June 30, 2023 |
| FY2024 | 15,574,718 | Year ended June 30, 2024 |
68% of the sample, unverified
Auditors tested 60 payments totaling $5.1 million, drawn from the $29.3 million⧉ DOH sent to EMS councils and the board. 42 payments -- $3.4 million, 68% -- lacked the documentation needed to confirm the money was spent as intended⧉. Inside that sample, 12 of 18 equipment purchases for local ambulance services, worth more than $727,000 of nearly $1.5 million tested, lacked the pre-approval form and/or the supporting documentation DOH's own rules require before a council can buy the gear⧉. Money moving the other direction fared no better: of 13 refunds councils sent back to the state, totaling $288,006, DOH could document only 6 of the 9 it sampled⧉ -- and one council's $9,991 refund, complete with a check and a Comptroller's Office date stamp, could not be found in the state's own accounting system at all⧉.
View data as table
| Payments sampled | 5,053,763 | 60 payments DOH made to the 13 EMS councils and the state board -- of $29.3 million disbursed over the audit period |
|---|---|---|
| Lacked required supporting documentation | 3,406,677 | 42 of the 60 payments (68%) -- DOH could not verify the money was spent for allowable purposes |
| Equipment purchases lacking pre-approval or documentation | 727,953 | 12 of 18 tested ambulance/equipment purchases (nearly $1.5M) DOH approved without the required pre-approval form and/or supporting documentation |
Five audits since 2010, the same finding every time
This is not a new problem. The Auditor General's office has audited DOH's administration of EMSOF five times since 2010 -- in 2014, 2015, 2018, 2023, and now 2025 -- and every single audit found significant internal-control weaknesses that the prior one had already flagged⧉. Reviewing the status of its own 2023 findings, the office rated one unresolved, one only partially resolved, and one -- DOH's review of councils' annual reports -- unresolved again⧉. "In audit after audit, DOH said things would change," Auditor General Timothy DeFoor said. "After 15 years of audits, DOH doesn't really know if the money it distributed to help EMS was used for allowable purposes 68 percent of the time. This is unacceptable."⧉
The fixes arrived after the window closed
DOH's own explanation for the repeat failure is staffing. Management told auditors that multiple leadership changes and staffing shortages hampered BEMS's ability to implement the new invoicing process meant to fix its oversight of EMSOF⧉. The bureau's current director wasn't hired until December 2023, after a nationwide search⧉ -- and with the staff position that normally reviews councils' annual reports left vacant, he completed all 14 of the FYE2024 reviews himself, contrary to DOH's own policy, and later admitted he didn't understand the complexity of the task and didn't devote the time it needed⧉.
DOH says it was approved to hire a financial manager for the bureau, but that position wasn't scheduled to start until June 30, 2025⧉ -- after the audited period had already ended. In its written response, DOH said it had increased funding to let regional councils hire their own staff dedicated to compliance paperwork, but that "due to recruitment timelines, these positions could not be filled until fiscal year (FY) 2024-2025"⧉.
Secretary of Health Debra Bogen's written reply said DOH is "committed to accountability and transparency in ensuring that state resources and specifically the Emergency Medical Services Operating Fund (EMSOF) are managed responsibly,"⧉ and the department agreed with the audit's findings and 16 of its 18 recommendations. It did not commit to withholding payment from noncompliant councils, citing the risk that doing so could disrupt EMS services the funding supports⧉.
- DOH could not verify that $3.4 million (68%) of a $5.1 million sample of EMS-fund payments -- 42 of 60 tested -- was spent for allowable purposes, out of $29.3 million disbursed over the three-year audit period.
- This is the fifth consecutive Auditor General performance audit of DOH's administration of EMSOF, going back to 2014, to find significant internal-control weaknesses that the prior audit had already flagged.
- $727,953 of nearly $1.5 million in tested equipment purchases lacked DOH's required pre-approval form and/or supporting documentation, and a $9,991 council refund -- check and date stamp included -- could not be located in the state's own accounting system.
- DOH attributes the repeat failure to leadership turnover and staffing shortages: its new bureau director started in December 2023, but the financial-manager position meant to fix oversight didn't start until June 30, 2025, and funded regional-council compliance staff couldn't be hired until FY2024-25 -- after the audited period had closed.
All figures on EMSOF revenue, distributions, sample testing, refunds, staffing, and recommendations come from the Pennsylvania Department of the Auditor General's Performance Audit Report: Pennsylvania Department of Health, Emergency Medical Services Operating Fund (November 2025), including the Executive Summary, Finding 1 (pp.8-20), Finding 2 (pp.21-27), Status of Prior Audit Findings (pp.30-33), and DOH's full written response (pp.34-40). This piece independently recomputed the three-year EMSOF revenue total ($45,252,019) from the report's own fiscal-year table and the two-thirds refund-documentation share (6 of 9 sampled refunds) from its refund-sample findings -- both reproducible from figures stated directly in the report. The $37.9 million combined-distribution figure and Auditor General Timothy DeFoor's quote come from the Auditor General's press release accompanying the report's release.
Sources(2) ▾
- Pennsylvania Department of the Auditor General, Performance Audit Report: Pennsylvania Department of Health, Emergency Medical Services Operating Fund (November 2025) (2025-11-20) — The primary document -- the fifth statutorily mandated performance audit the PA Department of the Auditor General has conducted of DOH's administration of the Emergency Medical Services Operating Fund (EMSOF), covering fiscal years 2022-2024. Source for every dollar figure, sample-testing result, staffing detail, and DOH's own written response in this piece. paauditor.b-cdn.net · original document
- Pennsylvania Department of the Auditor General, Auditor General DeFoor's Performance Audit of Emergency Medical Services Operating Fund Finds Continued Lack of Internal Controls (2025-11-20) — The Auditor General's own release accompanying the report -- source for Auditor General Timothy DeFoor's on-the-record quote and the $37.9 million total-distribution figure combining both the EMS and Head Injury Program shares of EMSOF, stated as a single number here but reachable in the audit body only as two separate figures ($29.3M EMS + $8.6M HIP). paauditor.gov · original document
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Pennsylvania's Department of the Auditor General⧉ tested 60 payments the Department of Health made to the state's 13 regional EMS councils and its advisory board between July 2021 and June 2024. Forty-two of them -- more than $3.4 million of the $5.1 million sampled, or 68% -- lacked the documentation needed to verify the money was spent for an allowable purpose⧉. It is the same finding five consecutive audits⧉ of this fund have reached since 2010.