Reports

This report was issued from a series of six reports taking an in-depth look at how six communities used the pandemic funding they received to address a wide range of needs. This report focused on Jicarilla Apache Nation Reservation in New Mexico with a detailed look at six of the 42 pandemic programs that provided funding to the community. This report was led by the Pandemic Relief Accountability Committee (PRAC) in coordination with HUD OIG as a project participant as well as additional Federal OIGs.

We audited HUD and its grantees’ monitoring of subrecipients and contractors in HUD’s Emergency Solutions Grants Coronavirus Aid, Relief, and Economic Security Act (ESG-CV) program to assess subrecipient monitoring in the program. ESG and ESG-CV grantees often rely on subrecipients and contractors to carry out ESG-CV-funded activities on behalf of the grantees, and are required to monitor subrecipients to ensure that the purpose of the grant funds awarded is achieved and funds are spent on only eligible applicants and activities. HUD is responsible for ensuring that grantees are performing...

We audited the City and County of Honolulu’s Department of Budget and Fiscal Services’ and Department of Community Services’ (City) fraud risk management practices for its Emergency Solutions Grants Coronavirus Aid, Relief, and Economic Security Act (ESG CARES Act) program with the objective of assessing the maturity of the City’s fraud risk management framework that encompasses control activities to prevent, detect, and respond to fraud. Fraudulent activity in the ESG CARES Act program can lead to significant financial losses; reputational damage to the grantee and the U.S. Department of...

We audited the California Department of Housing and Community Development (HCD) with the objective of evaluating HCD’s fraud risk management practices for its Emergency Solutions Grants Coronavirus Aid, Relief, and Economic Security Act (ESG CARES Act) program and assessing the maturity of its efforts to prevent, detect, and respond to fraud. Fraudulent activity in the ESG CARES Act program can lead to significant financial losses, reputational damage to the grantee and the U.S. Department of Housing and Urban Development (HUD), breach of fiduciary duty, and most importantly, loss of funding...

Servicers followed the COVID-19 pandemic foreclosure moratorium requirements. However, they could have better communicated the moratorium requirements to delinquent borrowers who were subject to foreclosure proceedings. This situation occurred because HUD did not require servicers to notify borrowers directly about the foreclosure moratorium and that occupancy would pause the foreclosure process. Borrowers who were not informed about the moratorium or impacts of vacancy could have abandoned their homes, not realizing that remaining in the home would have afforded them additional time to...

We audited the U.S. Department of Housing and Urban Development (HUD), Office of Native American Programs’ (ONAP) coronavirus disease of 2019 (COVID-19) recovery programs. We performed this audit to provide HUD with insight and a nationwide perspective on the challenges that grantees experienced with those programs. Our audit objectives were to identify 1) the information, guidance, and training HUD provided to the grantees for the ONAP COVID-19 recovery programs and 2) the challenges that grantees faced in implementing and using program-provided funding.HUD provided information, guidance, and...

We audited Nationstar Mortgage, LLC’s (doing business as Mr. Cooper (Nationstar)) compliance with the Federal Housing Administration’s (FHA) requirements for providing loss mitigation assistance to borrowers after their COVID-19 forbearance ended. We concurrently conducted a nationwide audit of servicers’ compliance with the U.S. Department of Housing and Urban Development’s (HUD) COVID-19 loss mitigation requirements (HUD Office of Inspector General (OIG) Report 2023-KC-0005). This audit complements that audit by examining how a single provider, Nationstar, provided loss mitigation for...

We performed an audit of loan servicers’ compliance with the Federal Housing Administration’s (FHA) requirements for providing loss mitigation assistance to borrowers after their COVID-19 forbearance ended. We initiated the audit based on the large number of borrowers exiting forbearance, because the loss mitigation programs available to these borrowers were new and created a risk for both borrowers and the FHA insurance fund when servicers do not properly provide loss mitigation. Our audit objective was to determine whether servicers provided borrowers of FHA-insured loans proper loss...

We audited the U.S. Department of Housing and Urban Development’s (HUD) Real Estate Assessment Center’s inspection process. The audit objectives were to determine whether the Center (1) ensured that public housing properties were inspected within required timeframes before the coronavirus disease 2019 (COVID-19) pandemic; (2) could improve its Big Inspection Plan for inspecting high-priority non-National Standards for the Physical Inspection of Real Estate (NSPIRE) demonstration public housing properties; and (3) had experienced delays in inspecting the physical condition of public housing...

We audited the U.S. Department of Housing and Urban Development’s (HUD) temporary policy for endorsement of loans with COVID-19 forbearance activity because an analysis of data in HUD’s systems showed that there may have been loans that did not comply with the policy’s requirements. The policy was one aspect of HUD’s broader emergency response to COVID-19, which also included an eviction moratorium and loan forbearance for borrowers experiencing financial hardship. The objectives of the audit were to determine (1) whether HUD’s temporary endorsement policy related to COVID-19 forbearance...

We audited the U.S. Department of Housing and Urban Development’s (HUD) efforts to proactively communicate information related to the coronavirus disease of 2019 (COVID-19) to homeowners with Federal Housing Administration (FHA)-insured mortgages. We initiated this work based on a U.S. Government Accountability Office report that identified helping borrowers understand the protections available to them as a key challenge and prior audit and evaluation work that found issues related to communication and COVID-19. Our audit objective was to assess HUD’s communication to homeowners with FHA...

We audited the U.S. Department of Housing and Urban Development (HUD), Office of Native American Programs’ (ONAP) Coronavirus Aid, Relief, and Economic Security (CARES) Act and American Rescue Plan (ARP) Act to identify drawdown levels for its block grant programs and assessed information ONAP made publicly available.As of October 4, 2022, grantees had drawn $231.6 million of the $300 million in CARES Act block grant funds and $135.8 million of the $735 million in ARP Act block grant funds. A total of $19.1 million of the appropriated funds was not authorized for access to grantees because...

In coordination with the Pandemic Response Accountability Committee, we conducted an audit to identify potential fraud schemes that could affect HUD’s pandemic funds. We reviewed the funds appropriated by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the American Rescue Plan (ARP) Act for the Tenant-Based Rental Assistance (TBRA), Project-Based Rental Assistance (PBRA), HOME Investment Partnerships, and Public Housing Operating Fund programs to identify the fraud risks and potential fraud schemes that they face while delivering services to the public.Our objective was to...

We audited the U.S. Department of Housing and Urban Development’s (HUD) Community Development Block Grant Coronavirus Aid, Relief, and Economic Security (CARES) Act program.Our audit objective was to determine what challenges grantees faced in using program funds for activities that prepare for, prevent, or respond to the coronavirus and its impact. We used a survey questionnaire to gather feedback and insight directly from 1,047 program grantees. As of July 30, 2022, grantees had drawn more than $1.79 billion, or 36 percent, of the $4.99 billion in program funds. We performed this audit to...

We audited the U.S. Department of Housing and Urban Development’s (HUD) Emergency Solutions Grants Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (ESG-CV) program. Our audit objective was to determine what challenges ESG-CV grant recipients faced in implementing the program and using grant funds. We used a survey questionnaire to gather feedback and insight directly from the 362 recipients of ESG-CV grants. At the time we initiated this audit in July 2021, ESG-CV grant recipients had spent $563,178,336 of available $3.96 billion grant funds. We performed this audit to assist...

We conducted a limited review of nursing home owners to identify their operational challenges and needs of nursing homes in responding to the Coronavirus Disease 2019 (COVID-19) pandemic. Our objective was to determine the biggest challenges operators of Section 232 nursing home facilities face related to the COVID-19 pandemic and whether nursing homes are prepared to meet their future financial obligations. Most of the owners who responded to our survey indicated that nursing homes experienced financial and operational challenges during the pandemic. These challenges included staffing...

We audited the U.S. Department of Housing and Urban Development’s (HUD) transitioning of offices from mandatory to maximum telework during the coronavirus disease 2019 (COVID-19) pandemic, based on a request from Representative Gerald Connolly, to review whether HUD was employing best practices and existing guidance when deciding whether or when to require Federal employees to return to their offices. Transitioning an office to maximum telework allowed HUD employees to voluntarily return to an office.We focused our audit on whether HUD complied with its internal Resuming Normal Operations...

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG), completed an audit to determine whether FHA-insured borrowers properly received the COVID-19-related forbearance. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), signed into law on March 27, 2020, provided a mortgage payment forbearance option for all borrowers who suffered a financial hardship due to the COVID-19 national emergency.We found that at least one-third of the nearly 335,000 borrowers who were delinquent on their FHA-insured loans and not on forbearance in November...

We conducted a limited review of the U.S. Department of Housing and Urban Development’s (HUD) Coronavirus Aid, Relief, and Economic Security (CARES) Act supplemental public housing operating funds (supplemental funds). Our objective was to assess public housing agencies’ (PHA) experiences and challenges and HUD’s efforts in providing guidance related to the administration of the supplemental operating funds under the CARES Act.We found that the PHA survey respondents generally cited positive experiences and no major challenges related to the administration of supplemental funds under the CARES...

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act made available $5 billion in supplemental CDBG funding for grants to prevent, prepare for, and respond to the coronavirus pandemic (CDBG-CV grants). Because of similarities, we reviewed 132 CDBG-DR program audits and evaluations issued from May 2002 to March 2020 to summarize the common CDBG-DR program weaknesses and risks for CPD to consider to help its CDBG-CV grantees effectively and efficiently manage their CDBG-CV program operations.We found that grantees had common areas of weaknesses and risks in the...

On March 13, 2020, the President of the United States declared that the COVID-19 pandemic was a national emergency. That same day, in accordance with section 1135(b) of the Social Security Act (the Act), the Secretary of HHS invoked his authority to waive or modify certain requirements of Titles XVIII, XIX, and XXI of the Act. To limit the spread of the virus, Federal, State and local governments urged individuals to stay at home and for individuals who test positive to quarantine, among other preventive measures. As a result, the usual and customary ways that many individuals obtained...

We conducted this engagement in coordination with the Pandemic Response Accountability Committee (PRAC) to gain an understanding of the U.S. Department of Housing and Urban Development’s (HUD) fraud risk management practices and develop an inventory of fraud risks that HUD had not already identified for the funds appropriated by the Coronavirus Aid, Relief, and Economic Security (CARES) Act for the Community Development Block Grant (CDBG) and Emergency Solutions Grant (ESG) programs.We identified five overall risk factors that contribute to the risk of fraud for the CDBG and ESG CARES Act...

The United States currently faces a nationwide public health emergency because of the COVID-19 pandemic. Federal regulations, effective May 8, 2020, required nursing homes to report COVID-19 information, such as the number of confirmed COVID-19 cases among residents, at least weekly to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network. Each week, CDC aggregates the reported information and sends the data to the Centers for Medicare & Medicaid Services (CMS) for posting to the CMS website. These data are used to assist with national surveillance of...

We audited lender reporting of COVID-19 forbearances for Federal Housing Administration (FHA)-insured loans in the Single Family Default Monitoring System (SFDMS). We compared default reporting data from SFDMS to loan data provided by five sampled servicing lenders that serviced a third of the FHA single-family portfolio. Our audit objective was to determine whether COVID-19 forbearance data available in SFDMS were consistent with the information maintained by loan servicers. We found that COVID-19 forbearance data available in SFDMS were generally consistent with the information maintained by...

We conducted a limited review of the U.S. Department of Housing and Urban Development’s (HUD) Office of the Chief Procurement Officer’s (OCPO) administration of five procurement activities under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The CARES Act and related Office of Management and Budget memorandums gave HUD flexibility in modifying existing contracts and required rapid delivery of CARES Act funds. Our objective was to determine what HUD had done to accommodate contractors’ pandemic-related issues while ensuring that HUD met its business objectives. In addition...

HUD OIG will summarize the conclusions/findings and recommendations reported by seven participating OIGs and the General Accountability Office related to natural disaster preparedness.  Our objective is to inform Federal agencies and the OIG community of the reported conclusions/findings and recommendations regarding preparing for and responding to natural disasters.
 

Hospitals that cannot control the spread of emerging infectious diseases within their facilities risk spreading a disease such as COVID-19 to patients and staff. OIG therefore developed a plan to assess the Centers for Medicare & Medicaid Services’ (CMS’s) controls related to hospital preparedness for emerging infectious diseases.The objective of this audit was to determine whether CMS designed and implemented effective internal controls related to hospital preparedness for emerging infectious diseases such as COVID-19.

As of March 31, 2021, HUD had disbursed $3.4 billion and obligated $7.4 billion of its $12.4 billion in CARES Act funds. Meanwhile, HUD has more than $1.6 billion in CARES Act funds unobligated. These funds have various expiration dates. For example, HUD has until September 30, 2021, to obligate $28 million of the remaining management and administration CARES Act funds and until September 30, 2022, to obligate more than $1.3 billion of the remaining Office of Community Planning and Development’s CARES Act funds. If HUD is unable to obligate funds properly before its appropriations expire, it...

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.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG), has completed a survey of the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on HUD’s Community Development Block Grant Disaster Recovery (CDBG-DR) grantees. Our objective was to determine the challenges that HUD and its CDBG-DR grantees are experiencing related to the COVID-19 pandemic and to help inform the Office of Community Planning and Development and Congress on the issues faced in responding to the pandemic.HUD’s CDBG-DR grantees across the country reported facing similar...

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. 

We prepared this memorandum to provide the Office of Housing at the U.S. Department of Housing and Urban Development (HUD) with key considerations from prior audits of the HUD Single Family Default Monitoring System (SFDMS) and the partial claim loss mitigation option. These audits identified HUD’s lack of effective controls to ensure that lenders reported default information accurately and in a timely manner, lenders promptly filed and reported partial claims, and partial claims fully reinstated delinquent loans. Prior audits also identified that the current design of partial claims results...

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.

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.

Telehealth is playing an important role during the public health emergency (PHE), and CMS is exploring how telehealth services can be expanded beyond the PHE to provide care for Medicare beneficiaries. Because of telehealth's changing role, we will conduct a series of audits of Medicare Part B telehealth services in two phases. Phase one audits will focus on making an early assessment of whether services such as evaluation and management, opioid use order, end-stage renal disease, and psychotherapy (Work Plan number W-00-21-35801) meet Medicare requirements. Phase two audits will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits to determine whether Medicare requirements are met.

President Trump declared a national emergency in response to the COVID-19 pandemic, which allowed the Centers for Medicare & Medicaid Services (CMS) to take proactive steps to support the response to COVID-19 through the use of section 1135 waivers. By means of this authority, CMS waived certain requirements in order to expand Medicare telehealth benefits to health care professionals who were previously ineligible, including physical therapists, occupational therapists, speech language pathologists, and others. CMS also amended regulations to allow home health agencies to use telecommunications systems in conjunction with in-person visits. We will evaluate home health services provided by agencies during the COVID-19 public health emergency to determine which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements. We will report as overpayments any services that were improperly billed. 
 

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provides qualifying individuals with a recovery rebate (economic impact payment) of up to $1,200 (or $2,400 if married and filing jointly), plus up to $500 for each qualifying child. Congress added a number of exemptions concerning the economic impact payments within the CARES Act; however, it did not exempt child support debt. According to estimates, up to 10.5 million noncustodial parents are delinquent in their payment of child support and could have their economic impact payments intercepted. Based on the significant impact that the CARES Act will have on the collection of delinquent child support due to the intercept of economic impact payments, we determined that the focus of our audit would be to determine whether selected State(s) have policies and procedures in place to ensure that State child support programs collected and distributed delinquent child support under the Federal Tax Refund Offset program.

Accurate, complete, and appropriately detailed race and ethnicity data for Medicare beneficiaries are critical to identifying and mitigating health disparities. As racial and ethnic disparities have emerged among those impacted by COVID-19, the availability and quality of data on race and ethnicity has garnered greater attention and scrutiny. This study will describe the extent to which Medicare's race and ethnicity data for beneficiaries are complete and accurate. We will compare these data to data from other sources. We will also determine the extent to which the Medicare beneficiary race and ethnicity data align with Federal data standards.

We audited the U.S. Department of Housing and Urban Development’s (HUD) response to COVID-19 to determine if it appropriately, effectively, and efficiently tracked, monitored, and issued Federal Housing Administration (FHA) refunds owed to homeowners with terminated loans. During our field work, the Coronavirus 2019 (COVID-19) pandemic began and as a result, we developed a second, more urgent audit objective to determine how COVID-19 has affected policies, procedures, and distribution of FHA refunds and whether HUD’s response was appropriate. We determined that COVID-19 generally did not...

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.

We conducted this limited review to identify the U.S. Department of Housing and Urban Development’s (HUD) Coronavirus Aid, Relief, and Economic Security Act (CARES Act) drawdown levels for the initial round of Emergency Solutions Grants (ESG) funding. In addition, we researched information published by grantees on how they have used and will use their funds. Our objective was to highlight the grantees’ (1) drawdown levels for the initial round of ESG CARES Act funding and (2) published information on how the funds have and will be used. Our review determined that as of July 1, 2020, the ESG...

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.

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.

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.

As part of the Office of Inspector General’s effort to provide oversight of the U.S. Department of Housing and Urban Development’s (HUD) relief efforts provided by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), we reviewed HUD’s communication to renters regarding the eviction moratorium found in Section 4024. The objective of our review was to highlight the progress HUD has made and identify areas for improvement. We found that HUD provided critical information to many of these renters through its website and published guidance. However, we identified several aspects of...

To address the COVID-19 pandemic, the Families First Coronavirus Response Act (FFCRA) and the Paycheck Protection Program and Health Care Enhancement Act (PPP) together appropriated $2 billion to reimburse providers for costs associated with conducting COVID-19 testing and testing-related items and services for the uninsured. Additionally, a portion of the $175 billion appropriated to the Provider Relief Fund by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and PPP will be used for treating uninsured individuals with a confirmed COVID-19 diagnosis. HHS, through the Health Resources and Services Administration (HRSA), launched the COVID-19 Uninsured Program Portal, a single electronic claims processing system for health care providers for submitting claims for reimbursements for diagnostic testing and treating uninsured individuals. We will determine whether claims for COVID-19 diagnostic testing and treatment services reimbursed by HHS through HRSA's COVID-19 Uninsured Program complied with Federal requirements.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG) conducted this study to follow up on information we shared previously regarding what information servicers of mortgage loans insured by Federal Housing Administration (FHA) are providing to borrowers regarding forbearance options available under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).We reported on April 27, 2020, that our review of 30 FHA servicers who service approximately 90 percent of FHA loans, revealed that FHA servicer websites provided incomplete, inconsistent...

As part of the Office of Inspector General’s (OIG) effort to provide oversight of the U.S. Department of Housing and Urban Development’s (HUD) relief efforts provided by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), we reviewed HUD’s responses to inquiries regarding forbearance and foreclosure relief. The objective of our review was to evaluate the accuracy of HUD’s responses to inquiries from borrowers, industry partners, and the general public regarding forbearance and foreclosure relief provided by the CARES Act. We found that HUD could improve its customer service to...

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.

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.

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.

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.

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.

The Families First Coronavirus Response Act provided $64 million in additional resources for COVID-19 response activities through the Indian Health Service (IHS) and requires coverage, without cost-sharing, for COVID-19 testing for American Indians/Alaska Natives, who receive health services. The Paycheck Protection Program and Health Care Enhancement Act provided $750 million for COVID-19 testing and testing-related services through IHS. From these two Acts, funding for COVID-19 testing to urban Indian organizations total $53 million and funding to IHS Federal health programs and Tribal health programs total $611 million. We will audit IHS's allocation and utilization of funding to urban Indian organizations, IHS Federal health programs and Tribal health programs. Specifically, our objectives will be to determine whether: (1) IHS allocated the COVID-19 funds to ensure that testing supplies were available to meet community needs, and (2) COVID-19 funds were used by IHS and grantees for testing, including other testing-related services, in accordance with Federal requirements.

 This work will provide details of the effectiveness of CMS controls over its Accelerated and Advance Payment Program (AAP) payments to providers and payment recovery. We will obtain data and meet with program officials to understand CMS's eligibility determination process for AAP payments and the steps CMS will have taken to recover such funds in compliance with the CARES Act and other Federal requirements. The objectives of our work will be to determine whether CMS made AAP payments to eligible providers and implemented controls to recover the AAP payments in compliance with the CARES Act and other Federal requirements. We will also evaluate a select group of providers to determine whether they were eligible for AAP payments, and their efforts to repay CMS in compliance with the CARES Act and other Federal requirements.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, Medicaid provider enrollment through State Medicaid agencies has been expedited under the SSA §1135 Authority to Waive Requirements during National Emergencies. Rapid loosening of established provider screening and background check requirements may limit a State's ability to identify providers who are not eligible to participate in Medicaid. Our objective is to determine whether the State agency and providers complied with Federal and State requirements for newly enrolled providers under the national emergency declaration and if the State established tracking controls for these providers as well as giving providers adequate guidance on waived enrollment requirements.

As information on rates of infection and outcomes for the ongoing COVID-19 pandemic emerges, numerous reports document racial, ethnic, and socioeconomic disparities in rates of adverse outcomes from COVID-19, including death. This study will review the locations of hospitals that received Provider Relief Funds, with particular attention to hospitals located in communities of color and economically disadvantaged communities that were disproportionately impacted by adverse COVID-19 outcomes (i.e., hospitalization or death).

With emerging information on rates of infection and outcomes for the ongoing coronavirus disease 2019 (COVID-19), numerous reports document a disproportionate burden of infection and deaths among communities of color and economically disadvantaged communities. This study will examine data that the Centers for Disease Control and Prevention (CDC) collects and maintains that can be used to assess racial, ethnic, and socioeconomic disparities in COVID-19 cases and outcomes, as well as how CDC uses those data as part of its activities to address the COVID-19 pandemic. We will also examine CDC's lessons learned about how to best protect communities of color and economically disadvantaged communities in future public health emergencies. 

Medicaid is a joint Federal-State program that pays for medical assistance for individuals and families with low incomes. All States currently provide coverage for outpatient prescription drugs within their State Medicaid programs. Under section 1135 of the Act, CMS may temporarily waive or modify certain Medicaid requirements to ensure that sufficient health care items and services are available to meet the needs of beneficiaries in times of an emergency. The coronavirus disease 2019 (COVID-19) pandemic highlights the need for States to efficiently and effectively respond to protect the needs of Medicaid beneficiaries. This audit will provide insights from State officials on action taken by States and DC to ensure Medicaid beneficiaries continue to receive prescriptions during the COVID-19 pandemic. We will interview State officials from several States and DC to determine actions taken or planned. Our objective is to review actions taken or planned by States and DC to ensure Medicaid beneficiaries continue to receive prescriptions during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented demand for diagnostic laboratory testing to determine whether an individual has the virus. Beyond the COVID-19 tests, laboratories can also perform add-on tests, for example to confirm or rule out diagnosis other than COVID-19. However, OIG has program integrity concerns related to add-on tests in conjunction with COVID-19 testing, particularly related to potentially fraudulent billing for associated respiratory pathogen panel (RPP) tests, allergy tests, or genetic tests. The Centers for Medicare & Medicaid Services has relaxed rules related to COVID-19 testing and other associated diagnostic laboratory testing to no longer require an order from the treating physician or non-physician practitioner (NPP) during the COVID-19 public health emergency. Relaxation of the physician ordering/NPP rules could allow unscrupulous actors more leeway for fraudulent billing of unnecessary add-on testing. This study will examine Medicare claims data for laboratory testing to identify trends in the use of RPP, allergy, and genetic testing and identify patterns of billing by laboratories that may indicate fraud and abuse.