Reports

To learn how communities across the nation responded to the pandemic, we initiated a multi-part review of six communities—two cities, two rural counties, and two Tribal reservations. This report is the sixth community-specific report and focuses on our work in Jicarilla Apache Nation Reservation in New Mexico, where we previously identified that recipients, including city government, small businesses, and individuals, received almost $80 million from 42 pandemic relief programs and subprograms. This report provides a closer look at ten pandemic programs and subprograms provided to Jicarilla...

This PRAC fraud prevention alert focused on some of the largest pandemic relief programs: the Small Business Administration’s (SBA) COVID-19 Economic Injury Disaster Loan (COVID-19 EIDL) program and Paycheck Protection Program (PPP), and the Department of Labor’s (DOL) pandemic-related Unemployment Insurance (UI) programs. In 2023, the SBA Office of Inspector General (OIG) and the DOL OIG estimated that the total amount of fraud and improper payments for these programs is nearly $400 billion. In this alert, the PRAC estimates the amount of potential fraud across these programs stemming from...

To learn how communities across the nation responded to the pandemic, we initiated a multi-part review of six communities—two cities, two rural counties, and two Tribal reservations. This report is the fourth community-specific report and focuses on our work in Marion County, Georgia, where we previously identified that recipients, including city government, small businesses, and individuals, received almost $39 million from 27 pandemic relief programs and subprograms. This report provides a closer look at six pandemic programs and subprograms provided to Marion County by six federal...

To learn how communities across the nation responded to the pandemic, we initiated a multi-part review of six communities—two cities, two rural counties, and two Tribal reservations. This report is the third community-specific report and focuses on our work in Sheridan County, Nebraska, where we previously identified that recipients, including city government, small businesses, and individuals, received almost $61 million from 31 pandemic relief programs and subprograms. This report provides a closer look at six pandemic programs and subprograms provided to Sheridan County by six federal...

To learn how communities across the nation responded to the pandemic during the first 18 months, we initiated a multi-part review of six communities—two cities, two rural counties, and two Tribal reservations. This report is the second community-specific report and focuses on our work in Coeur d’Alene, Idaho, where we previously identified that recipients, including city government, small businesses, and individuals, received almost $314 million from 45 pandemic relief programs and subprograms. This report provides a closer look at eight pandemic programs and subprograms provided to Coeur d...

To learn how communities across the nation responded to the pandemic, we initiated a multi-part review of six communities—two cities, two rural counties, and two Tribal reservations. This report is the first community-specific report and focuses on our work in Springfield, Massachusetts, where we previously identified that recipients, including city government, small businesses, and individuals, received almost $1.88 billion from 52 pandemic relief programs and subprograms. This report provides a closer look at nine pandemic programs and subprograms provided to Springfield by eight federal...

UI was already a strained system, but the pandemic exacerbated existing challenges and created new ones which lead to massive fraud. We sampled 45 cases and learned about the schemes and methods fraudsters used. Find out what can be done to improve UI for the future. Read our report to find out more.

The PRAC along with 10 of our member Offices of Inspectors General conducted this second phase of our review in order to provide insights on the experiences of the two cities, two rural counties, and two Tribal reservations that, during the first part of our review, received a combined $2.65 billion in pandemic relief funding across 89 pandemic programs and subprograms. We found that the six communities shared similar experiences even though their populations, demographics, locations, and contexts were unique. Specifically, we identified four themes which provide valuable insights to...

Recognizing the importance of an agile process, the PRAC, in coordination with CIGIE, hosted an Agile Oversight Forum in January 2023. This report captures the lessons learned and best practices shared by oversight experts from around the country at the Forum. The product is intended to be a starting point for offices and is not a standard for conducting oversight work.

During the pandemic, the contracts and grants workforce played a critical role in providing support to taxpayers, local governments, and other recipients through pandemic relief programs. The CARES Act directed the PRAC to review the sufficiency of contract and grant staffing and other resources from agencies across the federal government to determine if they had the resources necessary to adequately perform their duties. The PRAC conducted a survey of 29 agencies, and each provided their experiences on the impact the pandemic had on their agency’s ability to effectively perform their work...

While personnel shortages existed in the health care community before the pandemic, the pandemic exacerbated these shortages. Maintaining an appropriate level of personnel in health care facilities is essential to providing a safe work environment for health care personnel and safe care to patients. The Pandemic Response Accountability Committee’s (PRAC) Health Care Subgroup developed this report to share insights into personnel shortages across four select federal health care programs, or the providers they reimburse. Together, these four programs provide health care services to approximately...

Following up on our previous work which highlights the decentralized nature of identity fraud redress across the federal government, the Pandemic Response Accountability Committee commissioned the MITRE Corporation to conduct an independent study and define the elements needs for a whole-of-government approach to identity fraud victim redress. The report proposes a federal redress process that places the victim at the center and requires agencies to assist in a comprehensive manner. Framed as a single enterprise or “one-stop shop,” this process would provide an equitable experience for all...

The PRAC along with 10 of our member Offices of Inspectors General began a case study-based review, in part, to learn more about how much pandemic relief funding went to recipients within six randomly selected communities. Using a combination of federal, state, and local data sources, we identified that 10 federal agencies provided approximately $2.65 billion in pandemic relief funds to the six communities through approximately 89 pandemic relief programs and subprograms during the first 18 months of the pandemic (March 2020 through September 2021). We also found that tracking pandemic funds...

This update expands on our January 2023 Fraud Alert that identified 69,000 questionable Social Security Numbers (SSNs) used to obtain $5.4 billion in potentially fraudulent loans made in the COVID-19 Economic Injury Disaster Loan (EIDL) program and Paycheck Protection Program (PPP). As detailed in that Fraud Alert, PRAC data scientists, using our Pandemic Analytics Center of Excellence, identified the questionable SSNs after determining that the names, SSNs, and/or dates of birth used in connection with COVID-19 EIDL/PPP applications did not match Social Security Administration’s (SSAs)...

The PRAC’s Pandemic Analytics Center of Excellence (PACE) data scientists identified $5.4 Billion in potential identity fraud associated with over 69,000 questionable Social Security Numbers (SSNs) used on applications across disbursed loans in the Small Business Administration’s COVID-19 Economic Injury Disaster Loan Program and Paycheck Protection Program. Through collaborative verification methods with the Social Security Administration, we identified that these SSNs were used in connection with over 99,000 applications and warrant further scrutiny. The results of this Fraud Alert...

This report is a summary of the Pandemic Response Accountability Committee’s accomplishments between April 1, 2022, and September 30, 2022.

Recognizing how critical telehealth has been to the federal COVID-19 response, the PRAC Health Care Subgroup—which includes six Federal Offices of Inspectors General—worked together to provide insights on the use of telehealth and its associated program integrity risks.

The Pandemic Response Accountability Committee (PRAC) is issuing this Risk Advisory to notify Small Business Administration (SBA) management of potential identity or other fraud in its COVID-19 Economic Injury Disaster Loan (EIDL) program, EIDL Advance program, and Paycheck Protection Program. The PRAC identified possible identity or other fraud in one or more of these SBA programs involving 945 minors (under 18 years old) and 231 elderly individuals (80 years and older) who are also listed as household members in the Department of Housing and Urban Development’s Low Rent and/or Housing Choice...

This Insights Report highlights identity fraud related challenges in federal programs during the COVID-19 pandemic. By evaluating previous oversight work in this space from members of the PRAC’s Identity Fraud Reduction and Redress Working Group, this report presents best practices to reduce identity fraud before it occurs and to assist victims of identity fraud if it does occur. These best practices may be helpful for federal agencies to utilize moving forward. This report also identifies that across the federal government there is a larger focus on reducing identity fraud up front, while...

The Pandemic Response Accountability Committee’s (PRAC) Semiannual Report to Congress, covering the period from October 1, 2021 through March 31, 2022.

The Pandemic Response Accountability Committee (PRAC) is charged with conducting oversight of pandemic-related spending to prevent and detect fraud, waste, abuse, and mismanagement. In May 2021, we engaged MITRE, a not-for-profit federally funded research and development center, to conduct an independent study of lessons learned from the administration of pandemic-related emergency funding for unemployment insurance (UI) benefit programs in a sample of states. The objective of this study was to increase understanding of how states implemented pandemic UI benefit programs and how their...

The PRAC examined whether the Small Business Administration (SBA) Phase III fraud controls, which were applied to process Paycheck Protection Program (PPP) loans in 2021, would have likely detected the earlier fraud found in PPP criminal cases. SBA designed the PPP Phase III controls to address significant fraud identified in the earlier phases of the program and some were later used by the SBA in its Restaurant Revitalization Fund (RRF) program.

This insights report provides a contextual understanding of the cross-cutting challenges states faced within their unemployment insurance (UI) programs and highlights the substantial work that has been done by State Auditors to ensure their states’ UI programs are functioning effectively. This report examines four common insights across 16 State Auditor Offices: (1) UI workloads surged for states; (2) the claims surge exploited internal control weaknesses; (3) uncommon and varying fraud schemes began to occur as the amount of federal funding expanded; and (4) state workforce agencies...

The Pandemic Response Accountability Committee's (PRAC) Semiannual Report to Congress covering the period April 1, 2021 through September 30, 2021

The objective of this review was to identify specific gaps in transparency in award data for federal assistance spending in response to COVID-19. We looked at 51,000 awards worth $347 billion that supported the pandemic response (as of June 15, 2021). The report includes three findings, including we found more than 15,400 awards worth $33 billion with meaningless descriptions that make it difficult to know how COVID-19 relief money was used. The report includes five recommendations to help improve the transparency into COVID-19 relief spending.

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 Pandemic Response Accountability Committee (PRAC) supports independent oversight of $5 trillion worth of relief funds provided by Congress to respond to the coronavirus pandemic. This is an unprecedented amount of money, and it was disbursed quickly. The PRAC has worked with dozens of Inspectors General across the federal government to examine whether it was spent correctly and reached those it was intended to help. Together, we have issued more than 275 oversight reports that reveal common challenges facing agencies across major relief programs like unemployment insurance and loans to...

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...

The PRAC’s objective was to review pandemic-related federal contracts and identify first-time contractors and contracts awarded without competitive bidding. We found that first-time federal contractors received $4.4 billion worth of pandemic contracts in Fiscal Year 2020 and that $128 million was deobligated from contracts with first-time federal contractors during the same period. Additionally, we identified the four most common flexibilities identified to justify limited competition were urgency, only one source, simplified acquisition procedures, and authorized by statute. Of these, we...

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.

Federal agencies were allocated more than $5 trillion in pandemic response funding to be disbursed to the public and to state and local governments, where a state or local government could have received pandemic response funds from multiple federal programs to improve the overall pandemic response in their communities. Access to information about the total amount of funds received, the purpose of those funds, and the progress made toward achieving the program goals and objectives is not always centralized and can be difficult for the public to track down or may not even be available to the public. The PRAC will conduct impact case studies at 6 different locations and seek to identify the federal pandemic response funds provided to the 6 locations and the purpose of those funds, and to determine if the federal program spending aligned with the intended goals and objectives. The 6 locations identified for this project include: Springfield, Massachusetts; Coeur d’Alene, Idaho; Marion County, Georgia; Sheridan County, Nebraska; White Earth Indian Nation, Minnesota; and Jicarilla Apache Nation, New Mexico.

A commissioned study by MITRE that identifies gaps in federal data sources and how we can close them to improve the quality of the information we provide to the public.

Correctional and detention facilities present unique challenges in preventing and controlling the spread of COVID-19. When compared to the general population, a disproportionate number of COVID-19 outbreaks and deaths occur in jails, prisons, and detention facilities across the country. The Centers for Disease Control and Prevention has noted that the confined nature of correctional and detention facilities, combined with their congregate environments, heightens the potential for COVID-19 to spread once introduced into a facility. Individuals typically eat, sleep, and participate in activities...

The Pandemic Response Accountability Committee's (PRAC) Semiannual Report to Congress covering the period October 1, 2020 through March 31, 2021.

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.

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. 

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.

Since the beginning of the COVID-19 pandemic, the federal government has appropriated over $3.5 trillion to address the public health and economic crises. Given the changing nature of the pandemic and the federal government’s response, we re-visited our original top management challenges to ensure that the PRAC is providing timely information to Congress and the new Administration about the response efforts. The following four challenges have been added: Preventing and Detecting Fraud against Government Programs; Informing and Protecting the Public from Pandemic-Related Fraud; Data...

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.

This report examines COVID-19 testing efforts for six federal health care programs during the first seven months following the declaration of a public health emergency in the United States. Published by the PRAC Health Care Subgroup, the report takes a detailed look at testing data in each of the programs that, when combined, provide benefits or care for about 64 million individuals. We hope this report will help policymakers as they continue to develop and refine their testing efforts related to testing accessibility and availability for at-risk populations, cost effectiveness, and...

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.

A commissioned study that identifies gaps in federal data sources and how we can close them to improve the quality of the information we provide to the public.

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.

The PRAC released the Toolkit as a resource to assist federal, state, and local oversight agencies and professionals in conducting timely reviews and oversight of federal funding. The Toolkit provides OIGs and other oversight offices a set of guidelines, best practices, and lessons learned to help prepare these types of reports for CARES Act oversight and beyond.

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.

The Pandemic Response Accountability Committee’s (PRAC) first Semiannual Report to Congress, covering the period from April 1, 2020 through September 30, 2020.

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.

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.