Report | Sept. 3, 2020

Special Report: Controls Implemented by the Defense Health Agency to Control Costs for TRICARE COVID-19 Related Services (DODIG-2020-125)

Audit

Publicly Released: September 8, 2020

 

Objective

The objective of this audit was to determine the controls that the Defense Health Agency (DHA) implemented to control costs for health care claims related to the coronavirus disease–2019 (COVID-19) pandemic.

 

Background

COVID-19 is a viral respiratory illness caused by a novel coronavirus. The World Health Organization declared the global COVID-19 outbreak a Public Health Emergency of International Concern on January 30, 2020, and labeled the outbreak as a pandemic on March 11, 2020. The President declared a U.S. national emergency on March 13, 2020. As of August 3, 2020, the World Health Organization reported 17.9 million confirmed cases and 686,703 deaths. The United States reported 4.6 million cases and 153,757 total deaths with all 50 states reporting cases. As of July 24, 2020, the DoD reported that its beneficiaries received 59,442 COVID-19 tests, resulting in 4,531 positive diagnoses. As of July 10, 2020, according to data from the Military Health System Data Repository, the DHA paid $17.8 million for outpatient and inpatient claims for services related to COVID-19.

The Families First Coronavirus Response Act allocated an additional $82 million to the Defense Health Program for health services consisting of items and services related to COVID‑19. Section 6006(a) relates to the Act’s application with respect to TRICARE, coverage for veterans, and coverage for Federal civilians.  Specifically, it states that the Secretary of Defense may not require any co-payment or other cost sharing for COVID-19 testing, products related to testing, or the administration of such products.

Additionally, the Coronavirus Aid, Relief, and Economic Security Act allocated an additional $3.8 billion to the Defense Health Program of which $415 million was allocated for research, development, test, and evaluation to prevent, prepare for, and respond to coronavirus. In addition, the Coronavirus Aid, Relief, and Economic Security Act provided an additional $1.1 billion for contracts entered into under the TRICARE Program.