Former Gov. Andrew Cuomo's Department of Health undercounted the number of COVID-19 nursing home deaths by at least 4,100 and was unprepared to confront the deadly contagion before it ever arrived, state Comptroller Thomas P. DiNapoli said in an audit released Tuesday night.

DiNapoli's report pointed to a "persistent lack of funding for public health" over the last 10 years that left lawmakers unnecessarily handcuffed in the face of a devastating pandemic. Inaccurate death counts, mismanagement and the control over pertinent information under Cuomo led to a reality in which the actual number of nursing home deaths is still uncertain, the comptroller said. The findings are the latest refrain in a litany of scandals that emerged in Cuomo's final months in office before he eventually resigned amid sexual harassment allegations.

“The pandemic was devastating and deadly for New Yorkers living in nursing homes. Families have a right to know if their loved one’s COVID-19 death was counted, but many still don’t have answers from the state Department of Health,” DiNapoli said in a statement. “Our audit findings are extremely troubling. The public was misled by those at the highest level of state government through distortion and suppression of the facts when New Yorkers deserved the truth."

As its key findings, the comptroller's audit said the DOH "understated" nursing home deaths by at least 4,100, and at times during the crisis, by more than 50 percent. Officials with the DOH were unable to explain the discrepancies, according to the audit, which also said the "executive repeatedly reported incorrect data, inflating the perception of New York's performance against other states."

"These are not routine actions by state agencies undergoing an Office of the State Comptroller audit and raise serious concerns about the control environment at DOH," the audit said.

The report also said the DOH failed to respond to federal directives to survey nursing homes for infection control problems, reporting 20% of facilities between March and May 2020, compared to more than 90% for some other states. Throughout the audit, DiNapoli said, the DOH slow-walked requested data, limited auditors' contact with program staff and failed to provide all necessary documentation.

The state health department, in its official response to the audit, maintained that it provided accurate data and placed the onus on the Cuomo administration for any manipulation of information that may have occurred.

"The scope of health data that was released to the public by the prior Administration was determined by that Executive Chamber, not Department personnel, and any Department-issued data was accurately described," the DOH said in the audit. "Whatever criticisms may now be directed at the prior Administration relating to issues of transparency … those ultimately were matters for the prior Administration and not Department personnel."

In an email to Gothamist, Cuomo spokesman Rich Azzopardi said Cuomo addressed the nursing home death figures publicly while he was still in office. The reported death counts differentiated between those inside of nursing home facilities and those that occurred in hospitals.

"As the number of out-of-facility deaths were reported last January, this is not news," he said. "However what is peculiar is the comptroller’s release of this audit now — but no one has ever accused him of being above politics."

The former governor took to a Brooklyn church last month and railed against "cancel culture" and has spent part of his $16 million in leftover campaign funds on two campaign-style ads to rehabilitate his image. He's not said if he plans to run for public office again.

State Attorney General Letitia James said DiNapoli's audit supported her own January 2021 nursing homes report, which said the DOH "misrepresented" the number of nursing home deaths.

“This audit affirms many of the findings that we uncovered last year about the state’s response to COVID, most notably that DOH and the former governor undercounted the number of deaths in nursing homes by as much as 50 percent," she said in a statement. "I am grateful to Comptroller DiNapoli for bringing much needed transparency to this critical issue. My office will continue to monitor nursing home conditions and ensure the safety of our most vulnerable residents. If anyone has concerns about nursing home conditions, I urge them to contact my office.”

In a separate scandal, the attorney general released a report in August finding that Cuomo sexually harassed 11 women in violation of state and federal law. The Democrat announced his resignation soon after. A New York State Assembly report from November reaffirmed the assertion that Cuomo concealed accurate information about nursing home deaths. The Assembly report also said Cuomo sexually harassed multiple women and personally benefited from state resources while writing a memoir that was later deemed in violation of state ethics laws.

This story has been updated with additional comment.