Medicaid and ACA Enrollment Processes during the COVID-19 Pandemic
Economic and health impacts caused by the COVID-19 pandemic have left States facing increases in new applications for health insurance through the Medicaid and ACA Marketplace programs. Responding to the pandemic, including meeting the new enrollment and oversight demands, has taxed State health care systems. This evaluation will assess efforts by the States and CMS to effectively enroll residents impacted by the COVID-19 pandemic in Medicaid and ACA Marketplace plans. By identifying effective practices or any breakdowns in enrollment and oversight systems, this review would help improve the efficiency of State health insurance enrollment processes under both emergency and more typical conditions.
Surveys of BOP Federal Prison Staff and Inmates
In addition to the three surveys of staff at BOP-managed institutions, contract prisons, and residential reentry centers that DOJ OIG conducted in 2020 regarding BOP’s COVID-19 pandemic response, DOJ OIG is also conducting two additional surveys in 2021: a second survey of BOP federal prison staff, and a new survey of inmates.
Public and Indian Housing Supplemental Operating Funds
HUD OIG is conducting a limited review of HUD's administration of supplemental operating funds under the CARES Act. The CARES Act authorized an additional $685 million in public housing operating funds to prevent, prepare for, and respond to COVID-19. The review objective is to assess Public Housing Agencies' (PHA) experiences and challenges and HUD's efforts in providing guidance related to the administration of supplemental operating funds under the CARES Act.
Indian Health Service Use of Critical Care Response Teams To Support Health Care Facilities During the COVID-19 Pandemic
The Indian Health Service (IHS) is charged with providing comprehensive health care for approximately 2.6 million American Indians and Alaska Natives (AI/ANs). It is critical to ensure safe and accessible health care for AI/ANs during the COVID-19 pandemic. Prior OIG work found that IHS facilities often lack sufficient clinical and other staff, and identified numerous problems caused by staffing shortages, including limited patient access to specialists and problems with the use of contracted staff. The COVID-19 pandemic may exacerbate staffing shortages as IHS and Tribal hospitals continue to see more COVID-19 patients. As a response, IHS contracted additional staff by forming a Critical Care Response Team pilot program, which is designed to provide urgent medical care for COVID-19 patients in facilities with insufficient staffing. The teams are also charged with preparing and training frontline health care staff on evidence-based and best practices, supporting clinical decision making, and providing consultations and advice on hospital operations and how to manage critically ill patients. As of September 29, 2020, IHS had deployed five teams to provide services at six IHS-operated facilities and three tribally operated facilities and planned to make the program a longer-term part of IHS operations. Doing so could help remedy longstanding staffing shortages at IHS facilities. However, problems identified in prior OIG work indicate that IHS may have difficulty managing this contracted resource and integrating the teams into facility practices. OIG's review will use interviews with IHS and contracted staff, as well as document reviews, to assess IHS use of the Critical Care Response Teams, including development, management, and oversight of the teams, and IHS selection criteria for determining which facilities would receive deployments.
Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks
In response to the COVID-19 pandemic, CMS implemented a number of waivers and flexibilities that allowed Medicare beneficiaries to access a wider range of telehealth services without having to travel to a health care facility. This review will be based on Medicare Parts B and C data and will identify program integrity risks associated with Medicare telehealth services during the pandemic. We will analyze providers' billing patterns for telehealth services. We will also describe key characteristics of providers that may pose a program integrity risk to the Medicare program.
Audit of National Domestic Violence Hotline and Shelter-in-Place Orders During the COVID-19 Pandemic
The COVID-19 pandemic poses special challenges for victims of domestic violence. Because of economic and other uncertainties surrounding the pandemic and the shelter-in-place orders in effect for most States, abusers may exert further power and control over their partners. Victims in these States are more socially isolated and have fewer opportunities to connect with others who may be able to assist them. Isolated victims may be less likely to use crisis hotlines because their abusers are close by, and victims may face repercussions if they reach out for help. For fiscal year 2020, the Administration for Children and Families allocated $12 million for the National Domestic Violence Hotline (the Hotline). The Hotline operates a 24-hour, national, toll-free, and confidential telephone hotline for victims of domestic violence. It maintains a comprehensive resource database on services for these victims and is the only 24/7 center in the Nation that has access to service providers and shelters across the United States. The Coronavirus Aid, Relief, and Economic Security Act provided additional funding of $2 million for the Hotline, including hotline services provided remotely. Our objectives are to identify: (1) trends with the Hotline data that occurred during nationwide shelter-in-place orders and (2) whether the Hotline faced challenges that occurred during States' shelter-in-place orders and actions it has taken to address these challenges while continuing to support those affected by domestic violence.
Audit of HRSA's Controls Over Medicare Providers' Compliance with the Attestation, Submitted-Revenue-Information, and Quarterly Use-of-Funds Reporting Requirements Related to the $50 Billion General Distribution of the Provider Relief Fund
A combined $175 billion in funding from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act constitutes the Provider Relief Fund (PRF), which provides relief funds to hospitals and other health care providers for health-care-related expenses or lost revenue attributable to COVID-19 and to ensure that uninsured Americans can get testing and treatment for COVID-19. HHS allocated $50 billion for a General Distribution to Medicare providers.
Providers that receive PRF funds are subject to certain requirements for attestation, submission of revenue information, and reporting of quarterly use-of-funds to HHS. A provider that received a PRF payment and retained it for at least 90 days without contacting HHS regarding the payment is deemed to have accepted its terms and conditions. Further, a provider must submit general revenue data after receiving or when applying to receive a payment. Finally, according to the CARES Act, Division B, Title V, Section 15011(b)(2), no later than 10 days after the end of each calendar quarter, a provider that received more than $150,000 in total funds for the coronavirus response and related activities shall submit a report to HHS regarding the use of those funds.
As part of the OIG's oversight of the $50 billion General Distribution of the PRF, we will provide a snapshot of the effectiveness of the Health Resources and Services Administration's (HRSA's) controls over Medicare providers' compliance with the attestation, submitted-revenue-information, and quarterly use-of-funds reporting requirements. Specifically, we will review HRSA's internal controls and assess its policies and procedures related to these areas.
Coronavirus Aid, Relief and Economic Security (CARES) Act Provisions for Retirement Distributions
Assess the IRS's efforts to oversee the relief from taxes associated with early retirement distributions and the Required Minimum Distribution pursuant to the CARES Act.
The objective of this audit is to determine whether the DoD Education Activity developed and implemented controls in accordance with the Centers for Disease Control and Prevention and DoD guidance related to the spread of coronavirus disease–2019. We may revise the objective as the audit proceeds, and we will also consider suggestions from management for additional or revised objectives. We will perform the audit at the office of the Under Secretary of Defense for Personnel and Readiness, DoD Education Activity, and selected schools.
Audit of the DoD Coronavirus Aid, Relief, and Economic Security Act Awards to Increase the Defense Industrial Base Manufacturing Capacity
We plan to begin the subject audit in October 2020. The objective of this audit is to determine whether the DoD awarded Coronavirus Aid, Relief, and Economic Security Act funding to increase the Defense Industrial Base manufacturing capacity in accordance with Federal regulations and Defense Production Act authorities.