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We recommend that the Health Resources and Services Administration require the 10 health centers identified in our report as having charged unallowable COVID-19 supplemental grant funding costs to refund $787,152 (less any amounts health centers voluntarily refunded as a result of our audit) to the Federal Government.

We recommend that the Health Resources and Services Administration work with the 13 health centers identified in our report that may not have properly allocated COVID-19 supplemental grant funding costs to determine what portion of the $15,056,835 is allocable to their COVID-19 supplemental grant funding and require the health centers to refund the improperly allocated funds to the Federal Government.

We recommend that the Health Resources and Services Administration assist the 17 health centers identified in our report as having charged unallowable costs or potentially improperly allocated costs to implement HRSA's guidance for developing and maintaining financial management systems and internal controls that ensure that only allowable, allocable, and documented costs are charged to their HRSA supplemental grant funding.