Cox became the health department's director in 2009 after serving in a similar capacity for 14 years with the Tulsa Health Department; he previously worked 40 years at the Tulsa Health Department.
The audit said two Oklahoma City-County Health Department part-time employees were working full-time at the Tulsa Health Department. One was the Tulsa Health Department's human resources director.
On seven occasions, the other employee, a grant writer, used sick or other leave time at Tulsa and worked in Oklahoma City, the audit states. There were two occasions the employee reported working the same time at both locations.
Cox said both the Tulsa and Oklahoma City health departments allow flexible schedules and outside employment.
The audit reported that three employees were working for the nonprofit Partners in Public Health, Inc.; the health department sent an invoice to the nonprofit but it wasn't paid. Cox said the nonprofit since has reimbursed about $2,200 to the health department.
The audit also found four board members of the health department are also board members of the nonprofit which had not been audited since its establishment in 2000.
Cox said the nonprofit was reorganized in 2006, and its purpose is to raise private funds for the Oklahoma City-County Health Department.
Cox said he started a similar nonprofit, the Community Health Foundation, while he was director of the Tulsa Health Department.
The audit also expressed concern about several instances where timesheets were not signed by either the employee, a supervisor or both. Auditors said that could result in unrecorded transactions, misstated financial reports or misappropriation of funds.