Marti Arvin (marti.arvin@erlanger.org) is VP, Chief Compliance and Privacy Officer, Erlanger Health System, Chattanooga.
Since almost the first distribution of provider relief funds (PRFs) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Department of Justice and the Department of Health & Human Services’ Office of Inspector General (OIG) have been very public about pursuing enforcement actions. On February 1, one of the first criminal convictions occurred when the former owner of a Michigan healthcare company pleaded guilty to theft of public moneys, which carries a potential jail term of 10 years.[1] The plea was in connection with the misappropriation of $37,657 in COVID-19 relief money. In a presentation at the Federal Bar Association on February 23, OIG Chief Counsel Greg Demske indicated the OIG’s focus will continue to be in areas where it expects to recover the most money, one of which is fraud related to pandemic relief dollars. Demske indicated the OIG would use its Data Analytics Group in these efforts by identifying anomalies such as outlier distributions of CARES Act PRFs.[2] He also pointed out that the OIG has settled five civil monetary penalty cases over allegations of false certifications.[3]
In its report to Congress in October 2021, the Government Accountability Office indicated that while the Health Resources and Services Administration (HRSA) had taken some oversight actions for post-payment reviews of PRFs, its actions were limited and did not address what would occur after the first quarter of 2022.[4] It also noted that, while HRSA had identified overpayments through September 2021, it had not recovered most of those identified overpayments.
Organizations must stay on top of their use of the funds by identifying the applicable lost revenue and COVID-19–related expenses the PRFs are being used to cover. Providers who receive funds they do not use must repay them. Organizations must remain diligent about the tracking, reporting, and, if applicable, repayment of unused PRFs. Failing at any one of these could result in adverse actions by HRSA and enforcement actions by the OIG and Department of Justice. The consequences of noncompliance with the reporting obligations could be exclusion from receiving future payment, repayment, and debt collection.
