Evaluation of the Federal Reserve System’s Loan Purchase and Administration for Its Main Street Lending Program (MSLP)
In response to the COVID-19 pandemic, the Federal Reserve System established the MSLP—composed of five different lending facilities—to facilitate lending to small and medium-sized for-profit and nonprofit organizations. Through the MSLP, the Federal Reserve Bank of Boston (FRB Boston) purchased 1,830 loans amounting to approximately $17.5 billion from lenders; the majority of these loans were purchased during the last 2 months of the program. Following the purchase of the loans, FRB Boston is now responsible for administering the loans, including assessing overall credit risk and identifying substandard loans. FRB Boston leveraged third-party vendors to support both loan purchases and loan administration. We plan to assess the MSLP’s processes for loan purchases and loan administration, including the design, implementation, and operating effectiveness of internal controls.
Evaluation of the Federal Reserve System’s Vendor Selection and Management Processes Related to the Federal Reserve Bank of New York’s Emergency Lending Programs
As part of its emergency lending program, FRB New York operated six emergency lending facilities, five of which were supported by multiple vendor contracts. FRB New York awarded some of its emergency lending program–related contracts noncompetitively because of the exigent circumstances, and other contracts pose potential conflict-of-interest risks to the System. FRB New York’s reliance on vendors highlights the importance of its monitoring of vendor performance. We plan to assess the Board’s and FRB New York’s processes related to vendor selection and management for FRB New York’s emergency lending programs.
Use of States' Immunization Information Systems To Monitor COVID-19 Vaccinations
Immunization Information Systems (IISs) play an integral role in monitoring vaccine uptake in the population and meeting vaccination goals. While the Centers for Disease Control and Prevention (CDC) and other stakeholders have long invested significant efforts to establish plans and standards to guide improvements in IISs, State, and local jurisdictions have often struggled to make these improvements. CDC's work to collect and share data on COVID-19 vaccinations relies heavily on State and local IISs working with Federal systems, but the preexisting limitations of these systems pose challenges for CDC's goal of comprehensive immunization data being made available for clinical and public health uses. This study will examine State and Federal experiences using these systems to collect, share, and monitor data on COVID-19 vaccinations, and identify lessons learned that can improve vaccination data and monitoring for future mass vaccination campaigns as well as routine vaccination programs.
Audit of Health Resources and Services Administration's COVID-19 Supplemental Grant Funding for Health Centers
The Health Resources and Services Administration (HRSA) awarded nearly $2 billion in supplemental grant funding to 1,387 health centers nationwide in fiscal year (FY) 2020 to respond to the COVID-19 public health emergency. The funding was intended to support the health centers' activities related to the detection, prevention, diagnosis, and treatment of COVID-19, including maintaining or increasing health center capacity and staffing levels during the pandemic, and expanding COVID-19 testing. The performance period for each of these one-time supplemental grant awards, which HRSA began awarding in March 2020, is 12 months. Health centers were permitted to charge to their awards pre-award costs in order to support expenses related to the COVID-19 public health emergency dating back to January 20, 2020. We will determine whether health centers used their HRSA COVID-19 supplemental grant funding in accordance with Federal requirements and grant terms.
Audit of Indian Health Service's COVID-19 Vaccine Policies and Procedures for COVID-19 Vaccines Distributed to Tribal Health Programs
The COVID-19 pandemic has disproportionately affected American Indian and Alaska Native (AI/AN) populations nationwide. We will focus on IHS's coordination of the distribution, allocation, and administration of the vaccine to Tribal Health Programs. The objective of this audit is to determine whether IHS followed the Memorandum of Agreement for the CDC COVID-19 Federal Agency Vaccination Program and the IHS COVID-19 Pandemic Vaccine Plan to coordinate the distribution, allocation, and administration of the vaccines to Tribal Health Programs to protect AI/AN beneficiaries.
Yearend Review of Opioid Use in Medicare Part D in 2020
Identifying patients who are at-risk of overdose or abuse is key to addressing this crisis. The COVID-19 pandemic has made this need even more pressing. The National Institutes of Health recently warned that individuals with opioiduse disorder could be particularly hard hit by COVID-19, which is a respiratory virus that attacks the lungs. Respiratory disease is known to increase mortality risks among people taking opioids. This data brief would provide information on opioid utilization among beneficiaries enrolled in Medicare Part D in 2020.
Awardee Challenges in Implementing COVID_19 Vaccination Program
CDC Immunization and Vaccines for Children Cooperative Agreement awardees, which are typically State and large metropolitan area public health departments, plan for and oversee the vaccine distribution and administration process. Stakeholders have acknowledged challenges early in Phase 1 distribution and dispensing, and note that these challenges will likely span all three phases identified in the CDC's COVID-19 Vaccine Playbook. We will interview all awardees to identify the reported challenges they are facing while distributing and dispensing vaccines. We will also ask awardees about effective strategies to mitigate those challenges, new challenges they anticipate, and how HHS can best support them in distributing and dispensing COVID-19 vaccines. In doing so, this review will provide HHS with timely and actionable information to address challenges associated with the COVID-19 vaccination efforts.
Audits of Medicare Part B Laboratory Services During the COVID-19 Pandemic
Our preliminary analysis has shown that the number of non-COVID-19 tests billed for Medicare Part B beneficiaries during the COVID-19 pandemic has decreased compared with the 6-month period before the pandemic, and many independent laboratories have encountered challenges in providing COVID-19 testing. We will conduct a series of audits on Medicare Part B laboratory services during the pandemic that will initially focus on the effect of the pandemic on non-COVID-19 testing. The series of audits will also focus on aberrant billing of COVID-19 testing during the pandemic.
Audit of HHS Sole Source Contracts Awarded for COVID-19 Testing
HHS established contracts under the Public Health and Social Services Emergency Fund to prevent, prepare for, and respond to the COVID-Â19 pandemic. The contracts cover more than 600 COVID-19 testing sites in 48 states and the District of Columbia. The contracts utilize a Federal bundled payment program paid directly to retailers that receive a flat fee for each test administered, with participating retailers responsible for coordinating the full, end-to-end testing. The contracts that HHS awarded to contractors were sole source contracts totaling approximately $1 billion for COVID-19 testing. We will review the awarding and management of contracts for COVID-19 testing to determine compliance with applicable Federal statutes, regulations, HHS policies and procedures, contract terms and conditions, and the allowability of claimed costs.
Health Resources and Services Administration's Monitoring of High-Risk COVID-19 Grantees
The Health Resources and Services Administration (HRSA) is the primary Federal agency for improving health care to people who are geographically isolated and economically or medically vulnerable. HRSA should identify and mitigate risks related to awarding grants to health centers to minimize the potential misuse or loss of Federal funds. In spring 2020, HRSA awarded through three programs nearly $2 billion to approximately 1,380 health centers in response to the COVID-19 pandemic. To expedite distribution of this funding, HRSA did not require that health centers apply for grants. Instead, it made funds immediately available to health centers. Health centers had 30 days from the award release date to submit the information that is usually submitted, reviewed, and approved during the grant application process prior to a grantee receiving funding. We will determine whether HRSA had an effective process for identifying and monitoring high-risk health centers that received COVID-19 grants.