A review of Broward County’s pilot program that has already invested millions of taxpayer dollars into cardiac testing isn’t a universally-accepted test, has no verification that the people benefiting from it live in Broward, and doesn’t have adequate documentation for some expenses, according to a new audit.
The audit, delivered to county commissioners Monday, was conducted at the behest of County Mayor Nan Rich, who had already publicly shared her disagreement with a proposal to charge residents and visitors a new sales tax to pay for the free-to-the-patient cardiac testing. The tests costs taxpayers $1,444 each, according to the audit.
The county already has set aside $10 million for the pilot, which provides some Broward residents — those who have insurance so they can get follow-up treatment, and meet age and risk restrictions — a free cardiac CT scan, which is an imaging test that uses X-rays so doctors can see the heart and blood vessels. With an injection of iodine into the patient, a process known as “with contrast,” doctors can see the plaque in the coronary arteries that could potentially lead to trouble.
“I asked for the audit because I was concerned that I didn’t know where all this money was going,” Rich said Tuesday. “Now that I know, I’m not happy.”
On Tuesday, Broward County commissioners were scheduled to take the first vote on whether to place a sales tax item on the Nov. 5, 2024, general election ballot that would create a “Health Care Surtax.” If commissioners had agreed to it a second time, and voters were to approve the November ballot item, a quarter of a percent would be levied. The health care tax would have added 25 cents of tax to a $100 purchase, generating $125 million in revenue “on a conservative estimate” each year.
Instead, with the results of the audit released just the day before, Bogen pulled the item from Tuesday’s agenda, acknowledging “it needs more cooking” before he tries again.
He said he would continue to work to save lives, and said cardiologists could be opposed to the plan because they profit from conducting stress tests in their office, not from sending patients to hospitals for testing.
For mainstream cardiologists “it’s going to cut a lot of their revenue,” he said. “It interferes with their money. It’s all about money.”
As of March 31, 2024, there have been 1,736 tests completed as part of the pilot, and Broward County has spent more than $2.5 million to date. Of that, only one-quarter — $624,400 — has been used for the actual tests. Other money includes $926,525 for contract administration fees, $610,548 for marketing, and $345,000 for a physician consultant.
For now, the pilot project will continue through 2026 with no additional funding.
Among the findings in the audit, completed by the office of County Auditor Bob Melton:
Inappropriate test
The Coronary Computer Tomography Angiogram (CCTA) for asymptomatic people “is not universally accepted in the medical community,” according to the audit. The American College of Cardiology suggests that CCTA is rarely used unless the risk is greater than 20% based on a risk calculator.
“However, as being proposed, screening all Broward County residents with only 1 risk factor would fall well under the < (less than) 20% range, making the test rarely appropriate aka inappropriate,” according to the audit.
Is everyone from Broward?
There is no process in place to verify that an applicant is a resident of Broward, according to the audit.
Although applicants check a box as part of the online application indicating that they are Broward County residents when beginning the application, “we noted that no supporting documentation is required, and no verification is performed to validate the residency of an applicant,” the audit states.
In their review, they noticed that two out of 1,736 participants who received a test result resided outside of Broward County.
“The lack of appropriate verification of the residency of the applicant could result in persons who are not Broward County residents obtaining such services in place of actual Broward County residents. Additionally, serving persons living outside of Broward County may result in improper utilization of County funds for ineligible individuals,” the audit states.
Costs not supported with documentation
Initial invoices submitted by SydCura Health Solutions, the project administrator, and Dr. Claudio Smuclovisky’s consulting group Celymor, “did not include detailed descriptions about services provided or supporting documentation,” according to the audit.
“SydCura and Celymor started including details of the services provided after the County staff’s requests,” according to the audit.
They also reviewed county expenses for marketing, advertising, and outreach services for the pilot project, “however, our review noted that some expenditures were not supported by adequate documentation that would detail the type of services being paid.”
Follow-up medical care
Data for follow-up medical care or treatments or both after the tests are not collected.
The pilot project was “intentionally structured to avoid the County receipt or access to personally identifiable test data and to prohibit follow up with individual participants regarding their subsequent treatments and actions,” according to the audit. But, “ultimately, collection of follow up medical care and/or treatments (if any) after test results is an important indicator of the effectiveness of the Pilot Project and the impact it has to participants with abnormal and very abnormal test results. This would serve as a better indicator of the project efficacy to saving lives.”
Bogen’s website
Initial application information is solicited on a non-county website, according to the audit.
“The domain www.takehearttest.com is personally owned by a County Commissioner and not by the County,” according to the audit, and the county’s website directs people “to the County Commissioner’s personal website. Information collected include date of birth, name, address, telephone number, some current medical conditions, and some past medical conditions. At the time of this review, it was unclear whether the websites used to collect the applicant information have been evaluated to ensure they meet the County’s minimum-security requirements for applications that collect, transit and store Personal Identifiable Information (PII).”
Bogen said he spent his own money to buy the domain name to get the program started and never asked for reimbursement. He said long ago he turned over the website to the managers of the pilot program.
He said he has “no ability to get information and know who even goes there.”
By Wednesday afternoon, he said he notified county officials he would be transferring the domain name to the county.
Bogen said the data proves that the initiative is saving lives, with 59% of participants getting help, some of them with needed surgeries.
But Commissioner Michael Udine said he worried the audit findings could get the county in “trouble.”
He said the audit revealed “flaws” in the pilot and he wanted assurance it would be properly administered.
“It’s public dollars we’re talking about,” he said.
Lisa J. Huriash can be reached at lhuriash@sunsentinel.com. Follow on X, formerly Twitter, @LisaHuriash