An audit of American Samoa's LBJ Hospital says the hospital lacks internal controls for the handling of cash received from patients for the off-island medical referral programme.
The hospital used a corporate debit card to buy discounted fares from Hawaiian Airlines to allow patients to travel at a lower cost.
Before the discounted fare is purchased, a patient approved by an LBJ committee pays for the airfare, either in cash to the programme coordinator or by credit card at the pharmacy department cashier.
Last year, the hospital purchased 163,000 US dollars worth of airline tickets for off-island medical referrals.
The Territorial Audit Office has expressed concern at the lack of internal controls and says the risk is high that a significant amount of the money could be lost or stolen.