Infection Control at Home Health Agencies During the COVID-19 Pandemic
The coronavirus that causes the respiratory disease COVID-19 is especially dangerous for adults aged 65 years and older and those with underlying medical conditions. Medicare beneficiaries receiving home health services may be at a high risk of developing severe illness from COVID-19. Home health services are covered for the elderly and disabled under the Medicare program. Home health services may include skilled nursing care, physical therapy, speech-language pathology, occupational therapy, and medical supplies. Home health agencies (HHAs) must meet certain requirements to participate in the Medicare and Medicaid programs, including meeting infection prevention and control standards. On March 10, 2020, CMS issued a State Survey Directors Letter, "Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs)," to provide HHAs with guidance on addressing the outbreak and minimizing transmission. Home health workers often travel to several homes on a weekly basis, which increases their risk of exposure to the COVID-19 and increases the risk of infection among Medicare beneficiaries. HHAs must maintain a coordinated agencywide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases. We will interview corporate officers from the three HHA providers with the largest market share in 2019 as well as HHAs that have recently been cited by CMS for infection control and prevention deficiencies to determine the extent to which their infection control and prevention policy and procedures comply with CMS guidance regarding COVID-19.
HHS and ASPR Actions Related to Resources, Supplies, and Treatments Needed to Address COVID-19
HHS may take a variety of actions in response to an emerging infectious disease, including, but not limited to, actions related to resources, supplies, and treatments needed to address COVID-19. This study will examine actions taken by HHS, including the Office of Assistant Secretary for Preparedness and Response, to protect public health in response to the COVID-19 pandemic.
Sole Source Contracting
This cross-agency project will examine federal contracts related to the COVID-19 pandemic that were awarded to first-time federal contractors without competitive bidding.
Federal Student Aid's Implementation of Temporary Borrower Relief Under the CARES Act - Suspension of Involuntary Collections on Defaulted Student Loans
Evaluate the results of Federal Student Aid’s process for 1) suspending involuntary collection on defaulted Department-held loans in response to the national emergency due to the Coronavirus pandemic and 2) refunding payments involuntarily collected on defaulted Department-held loans in accordance with Department regulations and guidance.
Audit of USCIS' Ability to Process and Administer Immigration and Naturalization Benefits Requests During the COVID-19 Pandemic
Determine the effectiveness of U.S. Citizenship and Immigration Services’ (USCIS) technology systems to provide timely and accurate electronic processing of immigration and naturalization benefit requests while field locations, asylum offices and application support centers were closed or operating on a reduced workforce during the COVID-19 pandemic.
Audit of Data Quality in Selected in USAID PEPFAR Programs in Africa
This audit will look at the quality of data reported in selected President’s Emergency Plan for AIDS Relief (PEPFAR) programs to determine if weaknesses exist that may lead to inaccurate results reporting. The objectives of this audit are to assess the extent to which USAID has: (1) designed and implemented internal controls over collecting, verifying, and reporting PEPFAR data; and (2) identified and mitigated the effects of the COVID-19 pandemic on its internal controls over PEPFAR data quality.
Audit of Foundational Cybersecurity Controls for the U.S. Healthcare COVID-19 Portal and Protect.HHS.gov
The Protect.HHS.gov ecosystem and the U.S. Healthcare COVID-19 portal are both critically important systems contributing to the Federal pandemic response. The data collected by these systems are utilized in the response to COVID-19 by, for example, tracking the movement of the virus, identifying potential stresses in the health care delivery system, and provide information about the distribution of supplies. Without proper cybersecurity, the integrity and availability of the data are at risk and the impact to public health efforts could be significant if decisionmakers cannot rely on COVID-19 data from States, communities, and hospitals. We will determine whether HHS has implemented foundational cybersecurity controls to ensure the integrity and availability of Protect.HHS.gov and the U.S. Healthcare COVID-19 portal.
Infection Control and Emergency Preparedness at Dialysis Centers During the COVID-19 Pandemic
CDC has stated that beneficiaries with serious underlying medical conditions, such as end-stage renal disease (ESRD), are at higher risk for severe illness from COVID-19. Regardless of the current pandemic, dialysis patients are at high risk of infection because of weakened immune systems, coexisting conditions such as diabetes, and treatments requiring frequent use of catheters or insertions of needles to access the bloodstream. ESRD facility conditions for coverage regarding infection control and emergency preparedness are defined in 42 CFR 494 Subpart B. On March 30, 2020, CMS issued a revised memorandum providing guidance for infection control and prevention of COVID-19 in dialysis facilities. We will interview corporate officers from the three ESRD service companies covering more than 75 percent of CY 2018 Medicare reimbursements and 71 percent of dialysis clinics. Our objective is to determine whether ESRD facilities implemented additional infection control and emergency preparedness procedures in accordance with CMS and CDC guidance to safeguard high risk ESRD beneficiaries during the COVID-19 pandemic.
Audit of CARES Act Provider Relief Funds—General and Targeted Distributions to Hospitals
The Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act appropriated $175 billion for the Provider Relief Fund (PRF) to support health care providers affected by the COVID-19 pandemic. In April 2020, the Health Resources and Services Administration began distributing the funds through general distributions to Medicare providers based on 2018 net patient revenue and targeted distributions for certain provider types (e.g., providers in areas particularly impacted by COVID-19, skilled nursing providers, and providers in rural areas). Providers such as hospitals may be eligible for PRF payments from the general and targeted distributions. We will select for audit a statistical sample of providers that received general and/or targeted distributions. Our objective is to determine whether providers that received PRF payments complied with certain Federal requirements, and the terms and conditions for reporting and expending PRF funds.
Audit of Medicare Payments for Inpatient Discharges Billed by Hospitals for Beneficiaries Diagnosed With COVID-19
Section 3710 of the Coronavirus Aid, Relief, and Economic Security Act directs the Secretary to increase the weighting factor that would otherwise apply to the assigned diagnosis-related group by 20 percent for an individual who is diagnosed with COVID-19 and discharged during the COVID-19 public health emergency period. We will audit whether payments made by Medicare for COVID-19 inpatient discharges billed by hospitals complied with Federal requirements.