More Bad News: COVID Audits and HHS/DOJ RFIs

A number of COVID-related stories emerged this week that are worth following up on.

First, earlier this month, the U.S. Department of Health and Human Services (HHS) reminded providers that if they received COVID relief funding, they are not to balance-bill patients who were being treated for COVID.

Last week, HHS announced that they will be conducting a nationwide audit of hospitals that received COVID relief, to make sure of this. As part of the audit, the HHS Office of Inspector General (OIG) says it will look at how bills were calculated, and ask for documents that show a hospital is in compliance.

Also last week, the Government Accountability Office (GAO) released a report suggesting that HHS was bungling the management of this pandemic, and was certainly not ready for another one. The GAO placed HHS on a high-risk list, meant for government agencies that are at risk for fraud or mismanagement.

Specifically, the GAO said that HHS had not established clear roles and responsibilities across federal, state, and tribal partners in managing the pandemic.

Some other healthcare news coming out of Washington, D.C. include the following:

HHS has put out a request for input (RFI) on electronic prior authorization standards. The RFI is focused on how prior authorization systems can be better designed to reduce administrative burden.

The Trusted Exchange Framework and Common Agreement (TEFCA) was also finalized this month. TEFCA, mandated by the 21st Century Cures Act in 2016, is designed to get rid of individual legal agreements between health information networks (HINs) and improve the data sharing between those networks. The government can’t require anyone to adopt TEFCA, but HHS is hoping for enough voluntary use of the agreement to create a nationwide interoperability network.

The U.S. Department of Justice (DOJ) also released a request for public input on “ways to modernize federal merger guidelines to better detect and prevent illegal, anti-competitive deals.” It is likely that the mergers that will be under the DOJ’s microscope will include those that involve healthcare insurance companies and hospitals.

Actually, the number of hospital consolidations was down in 2021, but the size of the transactions was up. Eight of the 49 transactions last year were “mega mergers” in which the hospitals involved had average revenues of over $1 billion.

Programming Note: Listen to Matthew Albright’s live reports on federal legislation Mondays on Monitor Mondays 10 Eastern, sponsored by Zelis.


Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

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