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Shortly after Covid hit the shores of the United States, Congress passed several laws, with ample funding attached to them, to make sure that ALL Americans, regardless of whether they had health insurance, would be entitled to obtain Covid tests and vaccines, easily and quickly.
The Program, as enacted by Congress, was called the Covid-19 Claims Reimbursement to Healthcare Providers and Facilities for Testing Treatment and Vaccine Administration for the Uninsured Program (“HRSA Covid-19 Uninsured Program”). It was a great policy move and helped to get a much higher percentage of residents tested and vaccinated.
Unfortunately, its rules, regulations, and/or implementation have left much to be desired, and as such, the “uninsured” status of individuals receiving testing and vaccination has been wholly unchecked and otherwise not scrutinized by the United States.
“HRSA” is the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services. , Its mission is as the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable. Since March 2020, the HRSA Covid-19 Uninsured Program has provided claims reimbursement to health care providers for COVID-19 testing (as well as treatment and vaccine administration) for uninsured individuals.
The HRSA Covid-19 Uninsured Program is funded via (1) the FFCRA Relief Fund, which includes funds received from the Public Health and Social Services Emergency Fund, as appropriated in the FFCRA and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA) (Pub. L. 116-139), which each appropriated funding to reimburse providers for conducting COVID-19 testing for the uninsured, and (2) the Provider Relief Fund, as appropriated in the CARES Act and the PPPHCEA.
Individuals must meet the definition of an uninsured individual (FFCRA Section 1902(ss), as amended by section 1902(a)(10)(A)(i)(VIII) of the Act); Not be enrolled in a group health plan or health insurance coverage offered by a health insurance issuer (e.g. marketplace coverage, employer-sponsored health insurance, retiree health plans, and COBRA); Not be enrolled in another health care program funded by the federal government (e.g. Medicare, TRICARE, Veterans Administration, and federal employee health plans); and not be enrolled in Medicaid.
Provider Certifications Upon Enrollment
When enrolling as a provider participant, providers are required to certify “that to the best of its knowledge, the customers identified on the claim form were “Uninsured Individuals” at the time the services were provided.”
Providers are required to acknowledge, as a condition of participation and payment in the HRSA Covid-19 Uninsured Program, that each time the provider submits a Covid test or vaccine claim for reimbursement, the provider is certifying that to the best of its knowledge, the patients identified on the claim form are uninsured individuals at the time the services were provided.
Thus, providers have the express duty to ask customers themselves if they have coverage, AND independently check for health care coverage eligibility to confirm that the customer is uninsured.
As indications lead us to believe that multiple providers engaged in fraud by not doing so, thousands of claims submitted to the Uninsured Program were paid by the United States that should have been paid for by private insurance companies. The customers administered Covid-19 tests and vaccines did not meet the definition of an “uninsured individual” as required by the Uninsured Program, and, in fact, were insured by private insurance companies.
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