MONTGOMERY, Ala. – The Alabama Department of Public Health reimbursed vendors for nearly $28 million worth of unallowable or poorly documented services through its federally funded immunization program, a new audit from the Alabama Department of Examiners of Public Accounts says.
The audit found that at least $27.94 million of the ADPH’s reimbursements between July 1, 2020, and June 30, 2025 had inadequate documentation or were unrelated to contract purposes. Immunization program grant sub-recipients used allocated funds from the U.S. Department of Health and Human Services for several categories of improper uses, including fringe benefits and capital improvements, all spending prohibited by federal regulations or ADPH policy.
That included sub-recipients spending $1.1 million on entertainment, incentives and food; $934,000 on marketing; and $5,600 on political campaign materials and lobbying.
Two vendors also used $18,000 of federal immunization grant money for fundraising not related to COVID-19 awareness campaigns or vaccines. One event raised more than $300,000 for “an unrelated association.”
“The absence of controls and oversight exposed the ADPH to losses from unsubstantiated reimbursement requests,” the audit reads. “Addressing these issues is critical to safeguarding public funds, ensuring program effectiveness, and maintaining public trust in Alabama’s immunization efforts.”
The audit found that ADPH lacks the procedures to ensure grant reimbursements are only made for expenditures that qualify under the federal immunization program. Major issues within improper documentation included “vague expense summaries, lack of itemization, and insufficient evidence of allowability or performance,” the report says.
The ADPH did not comment directly on the audit’s findings. But the department did confirm that it requested the audit itself.
“The Alabama Department of Public Health (ADPH) requested the audit by the Examiners of Public Accounts, has been working closely with the auditors, and is now reviewing the finding,” it said in a statement to ADN.
The Examiners’ audit initially focused on a specific contract – Immunization Cooperative Agreement Grant contract C10114218 – at the request of State Health Director Scott Harris but expanded the search “due to the large number of issues noted during the review of the original subrecipient and its vendors.” The expanded scope included an additional 65 randomly selected entities that received federal grant money during the five-year window.
The audit tested 102 sub-recipients and vendors total. The ADPH received and spent $135.76 million in federal immunization grant money over the five years audited.
Because the audit didn’t track every dollar spent in the program, the report does not include the total cost of improper reimbursement.
The randomly selected group of 65 sub-recipients received $5.56 million in reimbursement, of which $3.65 million or 65%, the ADEPA found unallowable or inadequately documented.
Other problems
Outside of reimbursement issues, the ADPH’s “significant weaknesses” included poor equipment inventory and management, further running afoul federal and state guidelines, according to the audit.
The Alabama State Auditor’s Office requires that all agencies report to the auditor and track in an inventory log any property valued at more than $500. Because the state considers items purchased by sub-recipients and vendors with grant money to fall under the ADPH’s purview, it is the department’s responsibility to maintain the equipment within its own inventory listing, according to the audit.
Nearly $1.5 million of equipment purchases made with grant money – vehicles, defibrillators, a storage shed and a trailer – were not listed in the ADPH’s inventory log, the audit found. The ADPH was responsible for following up to ensure the sub-recipients were still using the property for intended purposes or that they had properly disposed of the item, which it did not do, per the audit.
“The ADPH should ensure that all relevant grant restrictions as well as instructions for property management, use, and disposal are communicated to sub-recipients and should verify that equipment obtained through the use of grant funds by sub-recipients is properly recorded on the ADPH’s inventory listing of non-disposable personal property,” the audit reads.
State Auditor Andrew Sorrell did not immediately respond to Alabama Daily News’ request for comment.
The Examiners held an exit conference with several high-ranking officials from ADPH to discuss the results of the audit. Chief Medical Officer Karen Landers, Chief Accountant and Director Shaundra Morris and Deputy Director, among others, were present.