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Office of Inspector General Announces Audit to Determine Compliance with PRF Balance Billing Requirements

For CEOs, CFOs, COOs, legal/compliance staff, government relations executives

The Health and Human Services (HHS) Office of Inspector General (OIG) has announced that it will perform a nationwide audit of Provider Relief Fund (PRF) recipients’ compliance with the prohibition on balance billing out-of-network COVID-19 patients.  

The PRF terms and conditions include a requirement that providers must not pursue the collection of out-of-pocket payments from presumptive or actual COVID-19 patients in excess of what the patients otherwise would have been required to pay if the care had been provided by in-network providers.  

As part of the work, the OIG will assess how bills were calculated for out-of-network patients admitted for COVID-19 treatment, review supporting documentation for compliance, and assess procedural controls and monitoring to ensure compliance with the balance billing requirement. The OIG is expected to issue its findings report in 2023.