Health Law Scan

Legal Insights and Perspectives for the Healthcare Industry

The HHS Office of Inspector General (OIG) has, for the last several years, been actively auditing hospices regarding their Medicare regulatory and billing compliance, with a national hospice audit in the works. Recently, OIG has notified certain hospices that it is conducting an audit of hospices’ compliance with CARES Act Provider Relief Fund (PRF) requirements and whether the hospices complied with certain terms and conditions and federal requirements related to the use of those PRF grants that were furnished to Medicare providers as part of the COVID-19 relief efforts in 2020 and 2021.

OIG has selected a sample of 30 hospices that received and retained PRF general distribution payments in 2020. These OIG PRF audits were expected, and indeed Congress allotted funding to OIG for such audits as part of its public health emergency response legislation. The OIG PRF audit begins with a letter to the hospice requesting certain specified records related to the hospice’s 2020 and 2021 expenses and lost revenues associated with its response to COVID-19. The letter also notifies the hospice that a member of the OIG Office of Audit Services staff will conduct an in-person or virtual site visit in connection with the PRF audit.

It is noteworthy that hospices are not being singled out by these OIG PRF audits—OIG is conducting audits of other healthcare provider types that received and retained PRF general distribution payments.

Contact your Morgan Lewis healthcare attorney if you have any questions on the OIG’s PRF audits.