A top official at HHS' Office of Inspector General on Tuesday said the watchdog is monitoring billing and claims data to ensure hospitals are not upcoding to take advantage of higher COVID-19 reimbursement rates.
"We are monitoring through our data accompanying bills and claims with a COVID diagnosis as a way to potentially upcode," Principal Deputy Inspector General for HHS Christi Grimm told members of the House Committee on Oversight and Reform.
Grimm's comments on upcoding were addressed to Rep. Glenn Grothman (R-Wis.), who asked Grimm about the theory floating around some conservative-leaning news outlets that providers may have an incentive to cite COVID-19 as a cause of death on death certificates, as Congress bumped Medicare reimbursement for inpatient COVID-19 care by 20%. There have been no publicly reported instances of such upcoding happening.
Grimm was until recently the acting HHS Inspector General, and she came under fire from President Donald Trump for publishing findings that hospitals surveyed in late March were experiencing shortages of COVID-19 testing and personal protective equipment. Grimm testified about the inspector general's former and current before the House oversight committee.
Grimm defended the report showing PPE and testing shortages as accurate, even though her office didn't independently verify hospitals' claims. But she characterized the report as a "snapshot in time" and said HHS has since taken steps to address hospitals' concerns. The HHS OIG currently doesn't have plans to conduct a similar survey that could serve as a comparison, Grimm said.
HHS OIG recently announced it is auditing HHS' distribution of $50 billion in provider grant funds to healthcare providers, but Grimm said the report will focus more on the execution of HHS' formula rather than probing the distribution methods themselves.
"We are looking at whether rules were followed in those calculations and whether they were distributed according to those rules. We are not second-guessing how those formulas were arrived on as part of our work," Grimm said.
Rep. Rashida Tlaib (D-Mich.) raised concerns that HHS' decision to distribute the funds based on 2018 net patient revenue disadvantaged safety-net providers. Grimm said looking into that issue is not currently part of their work plan, but that Grimm is open to facilitating further conversation on the issue.
