On October 22, 2020 the Department of Health and Human Services (HHS) updated its guidance on how hospitals and other providers should report their use of the nearly $165 billion in Provider Relief Fund payments that have been distributed for expenses and lost revenues attributable to the coronavirus pandemic. Reversing course from September, HHS says providers may use the funds to replace their lost gross revenue, not just their lost profits, from patient care. The guidance details how to report using the funds to cover revenue losses as well as expenses attributable to the coronavirus, and HHS also updated its FAQs on use of the funds.
While HHS’s latest instruction comes as a welcome relief for providers, the agency has also made clear that “HHS will have significant anti-fraud monitoring of the funds distributed, and the Office of Inspector General will provide oversight… to ensure that Federal dollars are used appropriately.” HHS will soon be examining the first reports on use of funds, due by February 15, 2021, from providers that received over $10,000 of CARES Act funding. And HHS isn’t the only one watching, as the media and Congress have already questioned the methodology behind the HHS disbursements, and whistleblowers may see rich opportunities through the False Claims Act (FCA).
Given this environment of heightened scrutiny, hospitals and providers should strive to rigorously monitor and account for their proper receipt and use of the Provider Relief Fund payments. While pandemic-related losses and expenses likely dwarf total payments (e.g., total losses through July were estimated to top $200 billion), some areas of caution include identifying where potentially overlapping funding sources might be available and HHS’s ban on balance billing for coronavirus-related care. As with any other important task, an ounce of prevention in using and documenting Provider Relief Fund payments will be worth a pound when trying to cure any investigation.
Read more to understand the nuances of HHS’s guidance and what healthcare providers can do to limit exposure.