Under the Health Resources & Services Administration (“HRSA”) Uninsured Program (the “Program”), healthcare providers who conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 primary diagnosis on or after February 4, 2020, or provided COVID-19 vaccine administration on or after December 14, 2020, were entitled to reimbursement through the Program based on the Medicare fee schedule. Since its conception, the Program has reimbursed participating providers approximately $18 billion in claims. As the dust has begun to settle, it appears, based on audits/investigations we have come across, the federal government is now poised to take enforcement action against providers related to the Program, as necessary.

By way of background, in order to qualify for reimbursement under the Program, participating providers were required to meet the following criteria:

• They must have been enrolled in Medicare. To that end, providers must certify that they are not terminated from participation in Medicare, precluded from receiving payment through Medicare Advantage or Part D, excluded from participation in Medicare, Medicaid, and other Federal health care programs, and do not have Medicare billing privileges revoked.
• Participating providers must also have verified that the patient was uninsured at the time the services were rendered, meaning the patient did not have coverage through an individual or employer-sponsored plan, a federal healthcare...

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