Medicare Compliance & Reimbursement

Expect PRF violations to remain under the OIG microscope through 2022.

The Department of Health and Human Services (HHS) has doled out billions in Provider Relief Funds (PRF) since the program’s inception to assist healthcare providers battling COVID-19. Now, the feds are investigating — and prosecuting — providers for COVID relief fund fraud.

Latest example: Amina Abbas, owner of 1 on 1 Home Health in LaPorte, Indiana, closed the home health agency in early 2020. But she held onto about $37,657 in HHS Provider Relief Fund payments. Abbas admitted she stole the funds by issuing checks to her family members for personal use, the Department of Justice (DOJ) says in a release. The agency “was never operational during the pandemic,” the DOJ points out.

Abbas, who pleaded guilty to one count of theft of public money, is scheduled to be sentenced on May 19. She faces a maximum penalty of 10 years in prison, the DOJ says.

“The charges against Abbas were the first criminal charges for the intentional misuse of funds distributed from the CARES Act Provider Relief Fund, money specially apportioned by the CARES Act to help health care providers who were financially impacted by the COVID-19 pandemic, to provide care to patients who were suffering from COVID-19, and compensate providers for the cost of that care,” the feds say. “These funds were critical to providing relief to health care providers and maintaining access to medical care during the pandemic.”

Tip line: “Anyone with information about allegations of attempted fraud involving COVID-19 can report it by calling the Department of Justice’s National Center for Disaster Fraud (NCDF) Hotline at 866-720-5721 or via the NCDF Web Complaint Form at https://www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form,” the DOJ adds.

Shady providers may also get caught up in the PRF audits the HHS Office of Inspector General (OIG) plans to conduct. The OIG has included general PRF audits on its Work Plan agenda multiple times, and last month announced audits specifically targeting hospitals’ use of PRF payments related to balanced billing for out-of-network patients (see Medicare Compliance & Reimbursement, Vol. 48, No. 3).

Meanwhile: In another recent COVID fraud case, a California medical supply company and its owner paid more than $62,000 to settle charges that it falsely certified its PRF eligibility.

Ocean Mind and Body in Encinitas and Laura Rausa attested in the HHS Provider Relief Fund Portal that Ocean was eligible to receive the PRF payment “because, among other things, it … provided after January 31, 2020, diagnoses, testing, or care for individuals with possible or actual cases of COVID-19,” the OIG says on its Civil Money Penalties settlement webpage. “However, OMB did not provide diagnoses, testing, or care for any individuals after January 31, 2020,” the OIG alleges.