Federal funding of District HIV/AIDS care providers could be in jeopardy following a Health Resources and Services Administration (HRSA) report that details problems at clinics in Washington and in the region.

Last summer, federal monitors found that some programs did not appear to be tracking key information about AIDS patients, including infection levels, medications and lab tests. HRSA's report said clinics might have paid their bills by improperly tapping federal Ryan White funds. Federal rules require the program to be a "payer of last resort," meaning clinics must bill Medicaid, private insurance, and other health programs before seeking reimbursement through Ryan White.

"My sense is that perhaps it may be easier to just submit a bill to the Ryan White program as opposed to going through a third-party insurer where you have to substantiate billing," said Douglas Morgan of HRSA.

Area AIDS advocates say lapses revealed in the report have been ongoing at some clinics for years, despite oversight that should have been performed by the District's HIV/AIDS Administration (HAA). An outside consultant found similar problems at more than 20 AIDS programs in the region in recent years, records show.

"This could be a potentially devastating situation for us," said longtime AIDS advocate Patricia Hawkins. "There's so much volume going through the medical clinics, and for a long time, no one had been adequately monitoring whether clients were actually eligible" for federal assistance.

The Washington area receives roughly $45 million in annual Ryan White funds. HAA is responsible for distributing a portion of the money to programs in Northern Virginia, suburban Maryland, and West Virginia.

HAA officials acknowledged the deficiencies and said they are working to correct the problems. If the lapses are not corrected, monitors could ask for the federal money back.

HRSA approved about $3 million over several years to help the District create a data-collection system. However, "the city is still working on it," Morgan said, noting that "things haven't happened as quickly as they should."