Any provider that has received payments from the Provider Relief Fund is subject to the audit.
Hospitals that have received distributions from the Provider Relief Fund (PRF) should be prepared this year for the prospect of a federal audit of their billing practices.
The Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) has announced it will conduct an audit of a sampling of PRF recipients to ensure they did not balance-bill presumptive or actual COVID-19 patients. A prohibition against such billing is part of the PRF terms and conditions, a violation of which could expose providers to recoupment of funds.
“We will assess how bills were calculated for out-of-network patients admitted for COVID-19 treatment, review supporting documentation for compliance and assess procedural controls and monitoring to ensure compliance with the balance-billing requirement,” OIG states.
The PRF terms and conditions state: “The [HHS] Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, [the] Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.”
This audit is specific to COVID-19 cases and does not pertain to the broader balance-billing ban that’s incorporated in the new surprise billing regulations.