Audit Shows Questionable Payments at Health and Human Services
A state audit identified seven areas of concern within North Dakota’s Department of Health and Human Services, including questionable payments, incomplete background checks, and gaps in food assistance.
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The following is from The North Dakota State Auditor’s Office.
An audit of the Department of Health and Human Services (DHHS) for the biennium that ended on June 30, 2025, has found seven areas of concern within the agency which totaled millions of dollars of questionable payments. The areas identified were:
Free Through Recovery and Community Connect - $1.4 Million in Payments Made Without Required Provider Engagement
Our team found that DHHS paid behavioral health providers even when required face‑to‑face engagement or contact attempts with participants did not occur. More than $1.4 million in payments were issued when minimum engagement standards were not met. The agency did not have procedures in place to detect or prevent these payments.
Payments to Free Through Recovery and Community Connect Participants
GAP payments through DHHS are one-time financial assistance for participants in Free Through Recovery or Community Connect. They are intended to fill a gap when someone in the programs needs short term help such as a cell phone or hygiene supplies. Many payments lacked proof of financial need, correct tracking, or timely receipts. Some reimbursements were made without required committee approval. We found 95% of Free Through Recovery receipts did not have evidence that financial need was determined, and 92% did not have evidence that other resources for financial help were exhausted. This could lead to providers adding items that benefit themselves or submitting the same receipt multiple times for several participants.
Child Care Workforce Benefit Payments to Ineligible Employees
This benefit helps childcare employees pay for their own children’s care, but some employees did not meet the 25‑hour weekly work requirement. Improper payments totaled an estimated $217,397 statewide.
Background Checks Not Being Completed for In-Home Services
Our team found that some providers who work in people’s homes did not have all the required background checks completed. Different divisions inside DHHS follow different rules, and the agency did not have a consistent process to make sure every provider met those requirements. Background checks would identify issues such as simple assault, possession of drug paraphernalia, and disorderly conduct. The projected error rate our team identified for background checks not being completed or initiated was 41%.
Verification of Home Visits – 34% Missing Electronic Proof
The purpose of Electronic Visit Verification (EVV) is to help verify that in‑home care services are actually happening where and when they should. Caregivers use a phone or an app to check in at the start of a visit and check out when they leave. This creates a digital record showing the time, location, and duration of the care. Our team found that providers were recording too many visits by hand. When a visit is entered manually, there is no electronic proof of where the caregiver was or whether the visit actually took place.
$4.7 Million Paid for Software to Track Electronic Visit Verification, Data Not Being Used
During the 2023-2025 biennium, approximately $4.7 million was paid to vendors who provide software to DHHS to track Electronic Visit Verification. We found that the vendor’s data was incorrect for 67% of the claims we reviewed. Additionally, DHHS is not using the data to monitor the accuracy of the claims.
Summer Food Assistance Program: 5,872 Children Who Should Have Received Food Assistance Did Not
DHHS oversees a summer food assistance program that provides food to children who are in need during the summer months. 5,872 children who should have received this benefit never did. Additionally, 1,610 ineligible children received it.
The full audit report can be downloaded here.
The North Dakota State Auditor’s Office conducts audits to improve government. With a vision to empower North Dakota citizens through outreach and education, the office is committed to transparency by sharing information with the people they serve, the citizens of North Dakota.
