Chilivis Grubman attorneys have cautioned providers on government enforcement efforts related to the CARES Act Provider Relief Fund and the likely audits that would follow the disbursement of the funds.  And Providers Relief Fund compliance is more important now than ever, as the government has announced PRF-related audits.

The U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) publishes projects (current and planned) for the fiscal year through its “Work Plan.”  Project types vary and may include studies and audits.  The OIG’s Work Plan is adjusted based on various factors, such as priorities, needs, resources, legislation, and to avoid duplicative efforts.  The Work Plan is updated monthly, which is far more frequently than the previous annual and biannual updates that occurred before 2017. 

Although the OIG provides only a synopsis of planned and current Work Plan projects, the OIG does provide reports for completed projects.  Continuous monitoring of the Work Plan platform allows interested parties to better understand government studies, audits, and areas that may face heightened government scrutiny.  

In May 2021, The OIG updated its Work Plan to include seven new projects, which includes PRF-related audits.

    1. NIH Oversight of Foreign Grant Recipients’ Compliance with Audit Requirements;
    2. Medicare-Related Capital Costs Reported by New Hospitals;
    3. Audits of Medicare Payments for Spinal Pain Management Services;
    4. Meeting the Challenges Presented by COVID-19: Nursing Homes;
    5. Impact of Expanding the Hospital Transfer Payment Policy for Early Discharges to Post-acute Care;
    6. Impact of the COVID-19 Pandemic on State Child Support Enforcement Programs; and
  • Audit of CARES Act Provider Relief Funds—Payments to Health Care Providers That Applied for General Distribution Under Phases 1, 2, and 3.

Audits of CARES Act Provider Relief Funds

Regarding the Audits of CARES Act Provider Relief Funds project, the OIG noted it will perform audits related to PRF distribution, which were disbursed in three phases.  Medicare providers received funds in the first phase.  Medicaid, dental, Children’s Health Insurance Program, assisted living facilities, and certain Medicare providers received funds in the second phase.  And certain behavioral health providers received funds in the third phase.  According to the OIG, the audits are “to determine whether payments were: (1) correctly calculated for providers that applied for these payments, (2) supported by appropriate and reasonable documentation, and (3) made to eligible providers.” The Work Plan does not provide additional information related to audits, except that the completion report is expected in 2022. 

Providers should review reporting instructions and note the reporting deadlines.  Providers should also ensure proper documentation is maintained and readily accessible.  Importantly, Providers should review the terms and conditions that were accepted as a condition of receiving the funds from the PRF.  To assist recipients with compliance, HHS maintains a webpage dedicated to frequently asked questions (“FAQs”) on various compliance-related issues, which was recently updated.  While the HHS FAQ webpage provides valuable insight on HHS’ interpretation of PRF requirements, HHS also modifies its responses to FAQs, so frequent monitoring is key. 

The attorneys at Chilivis Grubman – which include a former federal prosecutor – represent businesses and individuals in connection with government investigations and audits, including those conducted by HHS-OIG and the DOJ.  If you need assistance with such matters, please contact us today.