President Donald Trump has left a key watchdog position at the Department of Health and Human Services (HHS) vacant for more than nine months while the agency plays a critical role in the administration’s response to the coronavirus pandemic. The HHS Office of Inspector General (OIG), which is tasked with providing independent oversight for HHS, including the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the Food and Drug Administration, has been without permanent, Senate-confirmed leadership since June 1, 2019. From efforts to conceal critical information from the public, to the suspect treatment of a whistleblower, HHS is in desperate need of an independent watchdog to put public fears to rest and ensure that the U.S. response to this global pandemic is ethical and effective.

HHS OIG is the largest inspector general’s office in the federal government, with approximately 1,600 employees working to combat waste, fraud, and abuse in the agency’s more than 100 programs. It has been obvious from the beginning of this current health crisis that HHS needs a permanent watchdog in place. While public reports suggest that HHS Secretary Alex Azar has been “largely sidelined” in the Trump administration’s response to coronavirus, several other HHS sub-agencies play a critical role, including CDC and NIH. Last month, the Washington Post reported that according to a whistleblower, HHS sent “more than a dozen workers to receive the first Americans evacuated from Wuhan, China, the epicenter of the coronavirus outbreak, without proper training for infection control or appropriate protective gear.” To make matters worse, the whistleblower has also alleged that since reporting her concerns to officials in Azar’s office, she has been subject to retaliation including being “unfairly and improperly reassigned.” 

While these incidents demand more scrutiny and transparency regarding how HHS and the administration are combating the coronavirus, Trump administration officials have instead reportedly made coronavirus meetings classified, potentially delaying their response by excluding key staff. According to public reports, several administration officials revealed that meetings about the “scope of infections, quarantines, and travel restrictions” have been held in a high-security room at HHS since mid-January. This kind of secrecy and potential misconduct falls squarely within OIG’s jurisdiction.

HHS has also faced significant institutional problems that have undermined its ability to respond effectively to coronavirus. In its 2019 report on top management challenges for HHS, OIG identified among its list, “Harnessing Data to Improve Health and Well-Being of Individuals” and “Working Across Government to Provide Better Service to HHS Beneficiaries.” These areas still appear to be of concern. Earlier this week, Secretary Azar told CNN that HHS does not know how many Americans have been tested for coronavirus. He said, “We don’t know exactly how many, because hundreds of thousands of our tests have gone out to private labs and hospitals that currently do not report in to (CDC).” Secretary Azar noted that HHS officials were working with the CDC and its partners “to get an I.T. reporting system up and running hopefully this week where we would be able to get that data to keep track of how many we’re testing.” That same day, Politico reported that as HHS officials worked to negotiate an emergency funding package to fight the spread of coronavirus, on February 23, 2020, the agency’s email system crashed leaving some messages delayed for up to 11 hours, hindering the administration’s response.

While there are definitely areas of concern regarding HHS and its programs’ response to coronavirus, the health crisis also presents the need for more robust general oversight by HHS OIG. Last week, Congress passed and the President signed into law, a $8.3 billion funding package to bolster the government’s work to address the coronavirus. Unsurprisingly, the largest portion of that money was directed to HHS. In total, the bill made $3.1 billion in taxpayer funds available for the HHS secretary’s dispersal until 2024. Any federal agency with a sudden influx of emergency funds needs close supervision by an independent inspector general to ensure those taxpayer dollars are spent efficiently on the people and for the purpose intended. Other IG offices have routinely been tasked with similar oversight following the release of public funds in response to natural disasters.

Leadership at HHS OIG appears to have been in flux for nearly a year. In April 2019, then-HHS Inspector General Daniel Levinson resigned his post effective May 31. His resignation letter to the president did not provide a reason for his departure. Levinson’s longtime deputy Joanne Chiedi, took over as acting inspector general on June 1, 2019. Chiedi retired in December 2019, and in January 2020, Christi Grimm took over the office, becoming the Principal Deputy Inspector General for HHS OIG. 

While there is no doubt that Grimm and her team at OIG are working diligently to ensure that HHS officials respond to this crisis in an effective and efficient manner, both Congress and the IG community have raised concerns about the lack of permanent, Senate-confirmed leadership in IG offices. As Council of the Inspectors General on Integrity and Efficiency Chair and Department of Justice IG Michael Horowitz stated in January, “No matter how able or experienced an Acting Inspector General may be, permanent leadership at any organization is important for stability and long-term success.” Similarly, last fall, a bipartisan group of senators wrote to President Trump urging him “to take swift action” to address the IG vacancies at multiple agencies. They noted that, “While many acting IGs have served admirably in the absence of permanent leadership, the lack of a permanent leader threatens to impede the ability of these offices to conduct the oversight and investigations necessary to ensure that taxpayer dollars are protected, public safety risks are identified, and that whistleblowers who expose waste, fraud, and abuse are protected.” Still, President Trump has yet to nominate a permanent leader for HHS OIG.

Over the last three years, the President has demonstrated a shocking disdain for ethics and oversight, including from the internal watchdogs at federal agencies. So it should come as no surprise that he has left numerous IG offices without permanent leadership including several for his entire tenure as president. There has been bipartisan concern raised about these vacancies without significant movement to address them. 

Now, as our country faces its most significant public health crisis of the Trump presidency, that failure could undermine the efficacy of the administration’s response to the coronavirus and have dire effects on millions of Americans who are looking to HHS, CDC, NIH and other agencies for help.

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