The Department of Health and Human Services (HHS) recently announced additional audits of certain healthcare providers that received funding from the Provider Relief Fund (PRF). These audits will focus on whether hospitals that received PRF payments have complied with the surprise billing provisions of the PRF terms and conditions. HHS has long promised “significant enforcement” related to the PRF, a promise which is beginning to take effect.
The PRF was created by Congress through the CARES Act and was designed to provide financial relief to healthcare providers during the COVID-19 pandemic. Acceptance of a PRF payment is conditioned on, among other things, the provider agreeing to use the funds only for healthcare related expenses and lost revenue attributable to coronavirus, and to file reports demonstrating compliance with the conditions of the payment.
Providers who received and retained payments through the PRF are required to file reports justifying their use of the funds. Providers must report information on healthcare-related expenses attributable to coronavirus, lost revenue attributable to coronavirus, other pandemic assistance received, and administrative data. Providers who received more than $500,000 in aggregate payments are required to report some data elements in greater detail, including specific information regarding operations, personnel, supplies, equipment, facilities, and several other categories. Some providers will be required to report significant amounts of financial information in significant detail, which may require time to compile or calculate.
HHS’s newly-announced audit will review healthcare providers’ compliance with the surprise billing requirement, which prohibits healthcare providers from pursuing collection of out-of-pocket payments from patients with COVID-19 greater than what the patient would have otherwise been required to pay if their care had been provided by an in-network provider. HHS has indicated it will place additional emphasis on assessing how providers calculated the bills for out-of-network patients that were admitted for COVID-19 treatment.
The audit will also review providers’ compliance with the PRF’s other terms and conditions. Since the PRF was constructed to provide financial relief for treatment of COVID-19 patients, providers must maintain records and documentation that supports a patient’s COVID-19 diagnosis and the related treatments.
When the PRF was created, HHS promised significant enforcement action and audits of providers who received funds. As the pandemic recedes, providers that have benefited from the PRF should anticipate increased audit activity. Providers should work to ensure their billing practices and recordkeeping are up to date and in compliance with the terms and conditions of the PRF.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters. If you or your healthcare entity has any questions pertaining to the PRF or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or firstname.lastname@example.org.