Reports

We found that a full-time NPS employee wrongfully obtained State unemployment insurance and Federal Pandemic Unemployment Compensation.

We found that a USBR employee wrongfully obtained $28,524 in combined Unemployment Insurance and Pandemic Unemployment Assistance.

We determined that the BIA Great Plains Region did not hold three Tribes accountable for submitting CARES Act financial reports or narrative reports.

We determined that the Omaha Tribe did not follow applicable requirements in an agreement with the BIA.

We recommended the BIA and the BIE implement controls designed to prevent or detect instances of multi-dipping of pandemic response funds.

We determined that the Three Affiliated Tribes did not follow applicable requirements in an agreement with the BIA.

We determined that the Lower Brule Sioux Tribe did not follow applicable requirements in its agreements with the BIA.

Our inspection identified $155,575 in CARES Act and pandemic-related purchase card transactions with insufficient documentation.

Our inspection identified several issues with CARES Act and pandemic-related purchase card transactions made through September 30, 2020.

Our inspection identified several concerns with CARES Act and pandemic-related contract actions made through October 31, 2020.

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...

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...

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.

We reviewed the actions the BLM has taken to protect its employees, volunteers, and the visiting public during the COVID-19 pandemic.

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.

On March 27, 2020, Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was enacted. To date the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education to the BIE.This report presents the DOI’s progress as of January 31, 2021, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $613,068,783, and its obligations...

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. 

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education to the BIE.This report presents the DOI’s progress as of December 31, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $600,876,882...

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.

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was enacted. It included $8 billion for direct payments to Indian Tribes and $522 million of direct appropriations to the Bureau of Indian Affairs (BIA) and Bureau of Indian Education (BIE) for COVID-19 response. Given this infusion of funding, we examined the impact of COVID-19 on the Indian detention system from April 1, 2020, to May 31, 2020, including the actions the BIA and the tribes have taken to respond to outbreaks of this virus, and how other longstanding challenges have affected the BIA’s response...

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.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education to the BIE.This report presents the DOI’s progress as of November 30, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $582,466,112...

Under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) enacted on March 27, 2020, the U.S. Department of the Interior (DOI) received $909.7 million to prevent, prepare for, and respond to the coronavirus pandemic. The Office of the Secretary (OS) received $158.4 million of the DOI’s CARES Act funding and transferred funds to the U.S. Fish and Wildlife Service (FWS), National Park Service (NPS), Bureau of Land Management (BLM), Office of Inspector General (OIG), Bureau of Reclamation (BOR), and Office of Wildland Fire (OWF). As of November 30, 2020, 5.3 percent of the funding...

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.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education to the BIE.This report presents the DOI’s progress as of October 31, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $566,168,083...

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.

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.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education to the BIE.This report presents the DOI’s progress as of September 30, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $546,908,092...

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date, the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education (ED) to the BIE.In this report, we present lessons learned from and the risks identified in our earlier audit and investigation work related to the Coastal Impact Assistance...

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.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas, and a $153.7 million transfer from the U.S. Department of Education to the BIE.This report presents the DOI’s progress as of August 31, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $526,662,366...

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.

During the COVID-19 pandemic, the Bureau of Safety and Environmental Enforcement (BSEE) continued to fulfill its mission by performing safety and environmental inspections for offshore oil and gas operations. We reviewed the actions BSEE’s three regions—the Gulf of Mexico Region, Pacific Region, and Alaska Region—have taken to protect inspectors and offshore employees from COVID-19 and evaluated any impacts the virus had on inspections BSEE conducted since March 2020. We found that BSEE:• Developed, communicated, and updated COVID-19 guidance for all personnel involved with offshore...

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.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Among its provisions, the CARES Act provided the U.S. Department of the Interior (DOI) with $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas.This report presents the DOI’s progress as of July 31, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $502,312,984 and its obligations total $599,016,669.We are also monitoring the DOI’s progress on reporting milestones established by the CARES...

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which provided the U.S. Department of the Interior (DOI) with $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas.As part of the $756 million, the Office of the Secretary received $157.4 million to prevent, prepare for, and respond to the coronavirus across DOI operations, which includes wildland fire management. The DOI approved $11.3 million in funding for the DOI’s Wildland Fire Management (WFM) program through September 30, 2020...

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.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). To date, the CARES Act has provided the U.S. Department of the Interior (DOI) with $909.7 million, which includes direct apportionments of $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas and a $153.7 million transfer from the U.S. Department of Education to the Bureau of Indian Education in June.This report presents the DOI’s progress as of June 30, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures...

 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. 

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which provided the U.S. Department of the Interior (DOI) with $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas.As part of the CARES Act, the Bureau of Indian Education (BIE) received $69 million from the DOI to prevent, prepare for, and respond to the coronavirus pandemic. In addition to the CARES Act funding appropriated directly to the DOI, the CARES Act’s Education Stabilization Fund required the U.S. Department of Education to...

CARES Act Section 3610 allows Federal agencies to reimburse their contractors and subcontractors for any paid leave, including sick leave, that the contractors provide to keep their employees or subcontractors in what the section refers to as a “ready state.” Because these reimbursements present a number of risks and the U.S. Department of the Interior (DOI) is already receiving Section 3610 claims from contractors, the DOI urgently needs to put policies in place to ensure consistent oversight of reimbursed leave costs.In this management advisory memorandum, we offer three recommendations that...

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.

In response to the outbreak of the Coronavirus (COVID-19), the National Park Service (NPS) closed most park buildings, facilities, and restrooms, and in some cases, entire parks. With States now easing stay-at-home restrictions, and in response to the White House’s emphasis to open the national parks, some parks have already increased access by implementing a phased reopening. To facilitate a safe reopening, the NPS issued the National Park Service COVID-19 Adaptive Operations Recovery Plan to the parks on May 28, 2020. We contacted each of the 62 national park superintendents to report on...

The DOI will award most of its CARES Act funding to Indian Country through grants to the Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE). Of the $756 million, $522 million (69.0 percent) will be funded to Indian Country. As of June 13, 2020, $419,462,721, or 80.4 percent, had been obligated.These emergency response awards from the DOI–together with more than $8.7 billion in awards to Indian Country from other Federal departments—present a higher risk because they must be spent in a short period of time. In addition, we have identified Indian Country as a high-risk area...

As a result of the coronavirus disease 2019 (COVID-19) pandemic, State Medicaid programs have expanded options for telehealth services. Rapid expansion of telehealth may pose challenges for State agencies and providers, including State oversight of these services. Our objective is to determine whether State agencies and providers complied with Federal and State requirements for telehealth services under the national emergency declaration, and whether the States gave providers adequate guidance on telehealth requirements.

Title IV-E of the Social Security Act (the Act), as amended, authorizes the Federal Foster Care Program, which helps provide safe and stable out-of-home care for children until the children are safely returned home, placed permanently with adoptive families, or placed in other planned arrangements for permanency. Title IV-B of the Act authorizes Federal funding to States to promote flexibility in the development and expansion of coordinated child and family services programs. In response to COVID-19, on April 15, 2020, the Children's Bureau the operating division of the Administration for Children and Families (ACF) that administers the Title IV-B and Title IV-E programs at the Federal level—provided flexibility to State Title IV-E agencies related to (1) fingerprint-based criminal record checks requirements for prospective foster parents (allowing for name-based checks until fingerprint-based checks can safely be done), and (2) caseworker visit requirements (allowing videoconferencing visits to count toward the requirement that 50 percent of visits must occur in the child's home). On April 27, 2020, the Children's Bureau reminded States of additional flexibilities afforded by the Statute, including the authority to modify foster family licensing standards as long as the standards are applied to all of these placements in accordance with the requirements of the Statute. Additionally, States have the authority to set their own foster care maintenance payment rates including, at their own discretion, enhancing those rates for children who test positive for COVID-19.

We intend to survey all States and identify the States that adopted any new licensing regulations or policies and procedures as a result of the existing flexibilities in the Statute and the waivers provided by ACF. Based on the information gathered, we plan to identify three States and conduct separate audits to ensure foster care providers are safeguarding the health and safety of children during the COVID-19 pandemic and identify any vulnerabilities or gaps in policies or procedures that could place these children at risk. As part of these audits, we would ensure that criminal record checks for foster parents conducted via name-based checks were ultimately conducted through fingerprints whenever determined safe to do so.