HHS Inspector General Christi Grimm Testimony Transcript on Trump Administration COVID-19 Response

Chairwoman Maloney: (15:30)
Thank you all for being here today. We are privileged to be joined today by Christi Grimm. She is the Principal Deputy Inspector General of the Department of Health and Human Services, and she is performing the work and duties of the Inspector General. She is a career professional who has served under four presidential administrations, both Democratic and Republican. Last month, the HHS- OIG issued a report revealing the gravity of challenges that hospitals have faced during the Coronavirus crisis. From caring for sick patients, to obtaining protective gear for staff, to stocking basic medical supplies. This report was intended to help policymakers understand these challenges and to help hospitals overcome them, which benefits us all.

Unfortunately, President Trump personally attacked Ms. Grimm, and for no valid reason. His criticisms were baseless, and it seems clear that he just wanted everyone to pretend that there were no challenges and our health care system. Of course, we all know that was wrong. Ms. Grimm should not have had to endure these senseless personal attacks just for doing her job. Nevertheless, we thank her for tolerating them with dignity while she continues serving the American people. The HHS-OIG’s office is crucial in ensuring that the 175 billion the Congress gave to HHS for emergency relief under the Cares Act is spent effectively and efficiently. The HHS-OIG is also a member of the Pandemic Response Accountability Committee, which I am proud to have proposed in the Cares Act. The HHS-OIG and all inspectors general are more important now than ever. IOGs are playing a critical role in overseeing our government’s role, and then rooting out waste, fraud and abuse in our government’s response to the pandemic.

Regretfully in recent weeks, President Trump has taken steps to remove, replace, or attack numerous officials in the IG community, including at the State Department, the Transportation Department, the intelligence community, and the Department of Defense whose principal deputy inspector general had also been appointed to lead the Pandemic Response Accountability Committee. As the committee with jurisdiction over the entire OIG community, it is our responsibility to protect the IGs from political interference. With these reasons, on Friday, I joined with Majority Leader, Hoyer, Chairman Conley and Chairman Lynch, and introducing H.R.6984, legislation that will both strengthen the independence of IGs and protect them from political retaliation by requiring that IGs be removed only for good cause, and that documentation justifying removal be provided to Congress.

The requirement that IGs only be removed for cause was also introduced in the Heroes Act that passed the house, and I hope that all members, both Republicans and Democrats will support this important bill. I would also like to thank Chairman Conley the chair of the Government Operations subcommittee for the incredible work he’s done, and has been doing, to protect and strengthen our Inspectors General. Chairman Conley has been leading a series of IG briefings, and he and his staff were critical to helping to put this briefing together today. With that, I would now like to recognize the distinguished Ranking Member, Jordan, for any remarks he may have.

Ranking Member Jordan: (19:41)
Thank you Madam Chairwoman. The [inaudible 00:19:44] in your opening comments, you mentioned the entire IG community, but that seems a little strange because we have been pushing for weeks for you to bring in Inspector General Horowitz to talk about some of the recent reports, scathing reports he had on the fives operation, and you have yet to schedule a hearing or even one of these so called briefings that we’ve now grown accustomed to in the last several weeks. So there is a real frustration level with Republicans, Madam Chairwoman, about these briefings we’re doing. This so called briefings should be in an in person hearing to provide real transparency in the work of Congress. We must lead by example, States are opening up, Congress should get back to work just like States are.

In a briefing setting, the Democrats make up the rules as they go. For example, members questioning times and task briefings that range from three minutes to five minutes or even longer. On May 21st, 2020, just 10 minutes prior to the start of the select committee briefing, Democrat staff circulated, via email, written statements of the briefers. Republicans were not told this was an expectation, and we have no idea how long the majority had to review statements to prepare detailed questions prior to the briefing. Calling these meetings briefings, but live streaming them and using some parliamentary rules to conduct them, but not others, allows the majority to ignore minority rights that are fundamental to congressional committee proceedings.

We should be meeting in person, holding hearings pursuant to the house rules that have always guided us, but as Speaker Pelosi refuses to return to work, and at the very least we should follow… Then at the very least, we should follow the rules that the majority pass in the house just a week ago to actually hold hearings. At least those make an attempt to uphold the rights of all members on the committee.

Now focusing on today’s hearing or briefing or whatever you’d like to call it, any allegations that Christi Grimm was fired or removed for issuing a report is simply incorrect. She is still the acting Inspector General for the department pending the confirmation of the new Jason Weida. Jason Weida was nominated to be the permanent Inspector General on May, 1st, 2020. HHS has had multiple acting inspector generals since June of 2019. In April HHS-OIG released a report concluding the hospitals were suffering from a PPE shortage. This conclusion was based on a coached survey of hospitals conducted from March, 23rd through 27.

Essentially the OIG telephoned hospitals, and ask the small number of questions that pointedly did not include any effort to discern whether the policies implemented by the administration we’re in fact working at the time. I’m deeply concerned with the follow methodology that HHS-OIG used to create this bias report. Us Democrats continue to express outrage with the President’s removal of some inspector generals, but these concerns, I believe, are disingenuous at best. Democrats had no such concerns with oversight when former President Obama failed to a point a State Department IG for the entirety, for the entirety of Secretary of State Hillary Clinton’s tenure. That’s right, for 1,989 days, Secretary Clinton ran the State Department without any internal watchdog at all.

I’m hopeful that the majority will stop playing these partisan games and instead bring us back to D.C. to conduct meaningful oversight, to hold China accountable for this pandemic, and to start having real hearings in person like we are supposed to in the United States Congress. With that, I yield back.

E. L.: (23:15)
Thank you Ranking Member Jordan. Now we recognize Chairman Connelly. Mr. Connolly, you are now unmuted.

Chairman Connolly: (23:21)
Thank you so much. And thank you Chairwoman Maloney for hosting this briefing/hearing. I would like to make one point Madam Chairwoman, as you will recall, we did have Inspector General Horowitz before this committee about a month ago. It was before my subcommittee, you participated Chairwoman Maloney, I believe so did Ranking Member Mr. Jordan, so it’s not true that our committee has somehow avoided having Mr. Horowitz. We had him just last month, we would be happy to have them again. I want to thank our witness, Christi Grimm, Principal Deputy Inspector General for the Department of Health and Human Services, for briefing the committee on the important work her office is doing to highlight critical gaps in the Federal Government’s response to the Coronavirus pandemic.

It inspectors general are more critical to our nation than ever, as they oversee the distribution of the largest stimulus package in our nation system, $3 trillion and counting, and to ensure that our governance taking the right steps to save lives. A recent report issued by HHS Office of Inspector General details the severe shortages testing supplies and medical gear experienced by hospitals, and alluded to the disorganized nature of the Federal Response at the top, to the Coronavirus. IGs root out waste, fraud and abuse, and they speak truth to power. They call out mismanagement and inefficiencies no matter who doesn’t like it. They are essential to restoring trust in democracy and preserving accountability in every administration. That’s why we must stop this administration attacks on the IG community, and highlight their work.

IGs do more than save taxpayer dollars, although they return $22 for every $1 we invested in them. They help restore confidence in our [inaudible 00:25:24] and our agencies, and they ensure transparency and accountability for every dollar that’s appropriate. In this pandemic, the IG and HHS will play a critical role in conducting oversight of the government’s response to the Coronavirus. Stimulus legislation passed by Congress provided $175 billion in emergency funding relief for HHS to distribute to medical providers. Anti-fraud and auditing work from Ms. Grimms office, will help identify any waste and any fraud with respect to the distribution of these funds. In our [inaudible 00:26:06] work from her office helps identify it any problems we may incur, and with $175 billion and probably more to come, there’s got to be some.

Ms. Grimm announced that her office plans to review numerous aspects of the response to and preparation for the Coronavirus pandemic, including testing, health and safety preparedness, and operations of the National Strategic Stockpile. All of these reviews are important to the public, as well as for Congress, to understand what went wrong, what can be done to better be prepared for the future. As a statutory member of the Pandemic Response Accountability Council, PRAC, established by the Cares Act, the IG and HHS will lead the council to solve some health subcommittee, and play a leading role in developing the PRAC’s strategic plan.

Congress must do all it can to ensure that the IGs are able to conduct their work free from political retaliation at the presidential level or any other level, and for reporting on waste, fraud and abuse. I’m proud to join the Chairwoman, Chairwoman Maloney, to introduce a legislation that will do just that. Strengthen the independence of IGs, and protect them from undue political intervention and removal. I’m glad this legislation includes a higher threshold of termination of an IG, and requires the administration to provide the Congress documented evidence supporting any decision to remove any IG.

I’m also proud to sponsor by partisan legislation to hold IGs more accountable through increased transparency on the committee charged with investigating what I’m doing within the IG community [inaudible 00:27:58]. We protect that IGs because they are sources of accountability and credibility. With those protections, we also must ensure they’re pure than driven snow. Ensuring the independence of Inspectors General and their ability to work free from political retaliation is the best way to safeguard the trillions of taxpayer dollars that will be spent in response to this crisis and the recovery we know will follow. With that, I yield back. Thank you, Madam Chairwoman.

E. L.: (28:29)
Thank you Mr. Connolly. I will now recognize our briefer for her opening remarks. Ms. Grimm, you are now recognized.

Christi Grimm: (28:40)
Good morning Chairwoman Maloney, Ranking Member Jordan, Chairman Connolly, and other distinguished members of the committee. My name is Christi Ann grin, and I am the Principal Deputy Inspector General at the Department of Health and Human Services. I am a career civil servant with over 21 years of experience in ensuring the efficiency, effectiveness, and accountability in HHS programs and operations. On behalf of the over 1600 professionals of the HHS-OIG, I appreciate the opportunity to brief you about our oversight of the department’s COVID-19 programs and funding. The global COVID pandemic creates unprecedented challenges for HHS and for the delivery of healthcare and human services to the American people. Nearly 100,000 people have died, many more are seriously ill, and the effects are being felt in every corner of our country.

HHS is the lead agency responsible for the public health and medical services response. It is a monumental responsibility with life and death consequences. HHS is performing a vital role that covers areas such as vaccine development, testing, and guidance for staying safe, but also deploying medical volunteers to the front lines of healthcare, working with State, local and tribal governments to plan for respond to surges and directing billions in federal funds to bolster care and services for those most in need. In conducting oversight of this pandemic, we are drawing on our long history of overseeing the department’s emergency preparedness and response activities, including responses to hurricanes, other natural disasters and prior infectious disease outbreaks like H1N1 flu and the Ebola virus.

OIG uses expert staff and sophisticated technologies to carry out this work. In addition to performing our oversight, we share analytics and technical assistance with HHS officials to strengthen program integrity and management practices. We coordinate our work with key partners, including the Pandemic Response Accountability Committee, Federal, State, local, and tribal entities, and the Government Accountability Office. Later today, we will be posting to our website our strategy for oversight [inaudible 00:30:53] of HHS’s COVID response and recovery.

Our strategy has four goals. One, protect people, two, protect funds, three, protect infrastructure, and four promote effectiveness now and into the future. Today, we have 14 COVID related reviews posted to our public work plan with dozens of additional topics in development. It is our hope that this work will help inform decision makers, including the Department and Congress, as they respond to COVID and prepare for the future. Our first goal is protecting people. HHS programs touch the lives of all Americans, and our strategy therefore starts with protecting people. Our efforts here are wide ranging and include health and safety reviews, combating fraud schemes, and issuing information and guidance to the public.

In early April, we released our first report about the impact of the pandemic on healthcare. Results of telephone interviews with hospitals from across the country for the period of March, 23rd, through March, 27th. We were prompted to conduct this survey because we had prior experience with a study of hospital preparedness following the Ebola outbreak. We use the same random sample of 400 hospitals to collect the information about challenges in responding to coven, mitigation strategies hospitals were using to address challenges, and how the government could best support hospitals responding to COVID.

The report provided quick and reliable data from the ground to HHS, it’s operating divisions, responsible for oversight and support of hospitals, and to Congress. It also shared practical strategies hospitals reported to us that other hospitals could use in their own responses, including tips about managing patient flow, and bed capacity, and helping hospital staff access childcare. This was the first of many ongoing and planned audits and evaluations focused on protecting people during the pandemic, including reviews of the strategic national stockpile and COVID laboratory testing. Additional focus areas will include nursing homes, childcare facilities, and unaccompanied alien children.

We know from experience that frauds schemes proliferate during emergencies, as greedy perpetrators exploit fear and confusion to steal. It is despicable and it is happening during this pandemic. Scammers are targeting scared Medicare beneficiaries with scheme designed to steal their Medicare numbers. Scammers offer fake treatments and non-existent vaccines to the vulnerable seniors and others. Most recently, they are offering bogus contact tracing. Scammers entice people to click on a malicious link to find out whether they have been exposed to COVID. OIG has responded aggressively with our law enforcement partners in bringing these wrongdoers to justice. [crosstalk 00:33:44] is to protect HHS funds. OIG oversight of departmental expenditures has never been more important. As of mid May, HHS was appropriated $251 billion for COVID response and recovery. Further, Medicare and Medicaid are responding by implementing significant changes.

Further, Medicare and Medicaid are responding by implementing significant changes to coverage and other requirements in support of patients and the healthcare system. This includes implementing increased funding, such as the 6.2 increase in the federal match for Medicaid. Ensuring accurate payment is critical to our mission. And OIGs plan work will address contracts, grants, and other program payments.

This past Friday, we added a new audit to our public work plan that will determine whether the $50 billion and the general distribution from the provider relief fund was correctly calculated and distributed to eligible providers. We are also working to protect funds and collaboration with inspector general community partners serving on the Pandemic Response Accountability Committee. The committee is coordinating holistic oversight of federal funds, appropriated for the COVID response across the agencies, to deliver to the American public greater transparency and accountability for federal dollars.

Our third goal is rated related to cyber security. We seek to protect the health IT and data infrastructure that is critical to ensuring an effective response, including research. Our fourth goal is to protect the effectiveness of HHS programs. Of particular interest is the impact of flexibilities offered to providers during the emergency. HHS has waived coverage and payment rules to expedite access, to testing and treatments. We are interested in how the waivers affect patients, providers, and programs.

For example, we are looking at work examining the impact of expanded telehealth in Medicare. In conducting our audits, investigations, and evaluations, we are mindful of the critical work and safety of frontline providers and department staff. It is not surprising and that in the crucible of an emergency response, people trying to save lives and livelihoods accept greater risk, and sometimes make mistake, or realize unintended negative effects. Through our reviews, we seek to understand what works well and what did not to promote the effectiveness and efficiency of department programs.

We are balancing the need for robust oversight with minimizing unnecessary burden on providers and program staff caring for communities. As warranted, we are offering deadline extensions, delaying work where access to facilities is unsafe and adjusting our methods to avoid intruding on care. Recognizing that many Americans have lost loved ones, friends, neighbors, and colleagues, and that others are still bravely fighting, the importance of our mission is clear. We are dedicated to protecting millions of Americans and supporting the healthcare professionals, working so hard to serve the public during these trying times.

In conclusion, I want to thank the committee for its long standing and strong support for my offices independent work. I also want to thank the committee for its oversight work to ensure efficiency, effectiveness, and accountability, a mission that is shared across all offices of the inspector general. I assure you that the resources provided to us will be well-spent in service to the American public. I look forward to discussing our COVID-related work with you at this briefing and answering your questions. Thank you.

Speaker 1: (37:16)
Thank you. We will now move to the Q&A portion of the briefing. As a reminder, each member will have five minutes to allow enough time for all members to ask questions. Once recognized, please wait for confirmation that you have been unmuted before asking your question. Our first question will come from chairwoman Maloney. Ms. Maloney, you are now unmuted.

Carolyn Maloney: (37:37)
Thank you. Miss Grimm, thank you for participating today and for your extremely important work. I would like to focus my questions on the substance of that work. Your team surveyed more than 300 hospitals about their challenges in responding to the coronavirus crisis and brought to light extremely alarming findings. Being from New York city, I know firsthand the challenges our hospitals have had in responding to the crisis.

Your report explained that as the pandemic was escalating, hospitals did not have enough testing, or equipment because they lacked access to robust supply chains. As a result, they were forced to compete for crucial supplies like personal protective equipment and test kits. They competed against each other, against states, against the federal government and even against foreign entities. My question, Miss Grimm is, did your survey find that the federal government was doing enough to help hospitals get what they needed to prepare for this virus?

Thank you for your question for chairwoman. Our report, looking at a sample of hospitals nationwide, we went to 400 hospitals, we got a response rate of 85%, with 323 hospitals responding to us, provided relevant, timely, and useful information to federal, tribal state and local decision makers to help target their response efforts.

The goal of the work was to help to provide comprehensive information from the front lines in a time of national crisis. I would note that since the report has been released, the department has taken numerous actions to address the issues that we’ve highlighted in our report. We did find shortages of protective equipment, masks, gowns and reported expected shortages of ventilators. And as I said, the department has taken steps to address a lot of the issues raised in our report.

Thank you. In fact, hospitals reported that “Government intervention and coordination could help reconcile this problem at the national level, to provide equitable distribution of supplies throughout the country.” What specifically did hospitals want the federal government to do to help them access the supplies?

One of the questions that we did ask hospitals is what additional help they needed from the government. And they reported that they would like additional resources related to solvency that they believed increased cost of loss revenues threatened to disrupt hospital operations. And they also identified problems gaining supplies, the PPE that I had mentioned.

And these shortages resulted in some downstream effects, because they had to treat patients as though they were presumptive positive, which impacted bed capacity and staff and additional access to masks and gowns and other protective equipment.

Let me ask you about testing, which most scientists have said we need to do extensively in order to open up safely. This Congress has added at least $26 billion in appropriations to testings. Did hospitals report that supply challenges made it more difficult for them to conduct adequate testing?

Testing and access to tests and the time it took to get test results back was reported as a challenge. And again, that resulted in treating patients as though they were presumptive positive, which had several downstream effects on some of the issues that I mentioned related to [inaudible 00:41:36] [crosstalk 00:07:38].

According to your report, quote, you said, “Testing challenges hampered hospital’s efforts to reduce community spread, protect staff and care for patients.” Is that right?

I would note that the methodology for this report was interviews with hospitals. And these are the challenges that were reported to us. We did not go behind and independently verified their responses. These are their words.

Well, unfortunately, hospitals in New York and elsewhere still do not have access to all of the testing, protective equipment and medical supplies that they need. We had a briefing last week in the select sub committee on the coronavirus crisis, and frontline healthcare workers told us that they still do not have enough testing, or equipment to protect themselves, or their patients. And that was nearly two months after your survey. Miss Grimm, what do you hope HHS and other federal agencies well gain from your report?

The report was a snapshot in time for March 23rd, through March 27. It is just the beginning of the work that we are doing, looking at the coronavirus response. I will note that we do have two active jobs related to testing. The first is an examination of FDA’s role in facilitating tested for COVID-19, which does examine emergency use agreements. And also an audit of CDC’s test kits to state public health labs. And we’re doing some other work that that is examining potential additional topics in testing.

Well, I say it’s unfortunate our leaders did not act on the information that you provided. But we have an opportunity to do so now. Scientists are reporting that there will be another wave, another wave coming at us of the coronavirus, possibly in the fall. We have an opportunity to work together in a bipartisan way to prepare, be ready, and make sure the hospital’s have the protective gear and the testing that they need.

Again, I want to thank you for your participation and your government service and your dedication to ensure that our federal government is working as it should be. I thank you again, and I yield back.

Thank you, chairwoman. Ranking member Jordan. You are now unmuted.

Jim Jordan: (44:19)
Thank you. Thank you Madam Chair. Ms. Grim, when did you do the survey and report again?

I’m sorry. Ranking member Jordan, could you say that again? I didn’t hear you.

Jim Jordan: (44:31)
Yeah. Thanks for being with us. When did you do your survey and report? When did that take place?

We surveyed hospitals from March 23rd, through March 27th of this year.

Jim Jordan: (44:43)
So two months ago, right?

We released the report on April 6th. It was March 23rd through March 27th and we released the report on April 6th.

Jim Jordan: (44:53)
You did the survey two months ago. Have things changed in the past two months. Just take the question of ventilators. Is it a different situation today than what we assumed was going to be the case in March, relative to ventilators as an example?

Yes, and the department has taken many actions to address the issues that we had identified in our report.

Jim Jordan: (45:21)
As another example, I saw a news report last week that said there are now testing centers where no one’s showing up to get tested. Is that accurate too?

We do not have any information on that.

Jim Jordan: (45:34)
Ms. Grimm, why did we shut down the economy?

We do not have any work looking at that issue.

Jim Jordan: (45:41)
No, no. I’m just asking in general. Why did the country, why did state, what was the reason that we shut down the economy 10 weeks ago?

To reduce the spread of the COVID virus.

Jim Jordan: (45:57)
Of course, but what specifically? We wanted to flatten the curve, reduce the spread, save lives. And of course that’s critically important. We all want to protect people and save lives, but there was a specific reason given. I’m just wondering if you recall what that was.

I’m sorry, ranking member Jordan, I don’t have any information on why the country were shut down.

Jim Jordan: (46:21)
Well, I think it’s common knowledge that we were told by elected officials that we shut down in the economy and engaged in all the practices we did too. Flatten the curve, certainly save lives. But specifically, we did it to not overwhelm our healthcare system. You agree that that was the reason given?

That is something that sounds right to not overwhelm our healthcare system.

Jim Jordan: (46:52)
Yeah, so I’m asking, did we accomplish that goal?

I don’t have any information on how hospitals are fairing at this moment. We do have some additional work looking at a hospital preparedness in CMS’s controls of looking at implementation of emerging infectious diseases and how CMS has provided oversight of that. And how a select group of hospitals are adhering to that role. I do not have updated information at this moment if hospitals are experiencing [crosstalk 00:13:29].

Jim Jordan: (47:29)
I’ll tell you how they’re doing. Hospitals around the country and healthcare system had to lay off 1.4 million workers in the month of April, alone. I’ll tell you how they’re doing. They’re not doing very well. Because what we did is an essence, and you can almost say we bankrupted some of these hospitals by the practices we took.

Jim Jordan: (47:47)
We certainly didn’t overwhelm them, but what we did is we forced them to lay off people. And in some cases, I think we bankrupted these hospitals. And yet the Democrats are having a hearing on a survey you took two months ago where everything has changed. And the stated goal for the entire shutdown was certainly met, I think, to the detriment of so many hospitals. And so I have a simple question. You think it’s time to get back to work?

I would not be able to comment on whether or not it is time to go back to work.

Jim Jordan: (48:17)
Well, it sure seems like it is. I know hospitals are itching to start their elective surgeries and elective procedures, their scans and the things that they do that generate revenue for them. It certainly seems appropriate that we, we get back to work and start letting them operate. Particularly now that it’s been 10 weeks. And frankly, as I said before, 10 weeks, since we had your survey, I appreciate the work you do, I appreciate being with you today, Madam Chair. I yield back.

Speaker 1: (48:51)
Thank you, Mr. Jordan. Next, we will go to Mr. Chairman Connolly. Mr. Connolly, you are now unmuted.

Gerry Connolly: (48:58)
Thank you. And welcome Ms. Grim for the committee. Madam Chairwoman, before I start, I just want to correct a misstatement by Mr. Jordan, who argued that Democrats were silent when there was no, IG at the state department. As a matter of fact, the two ranking Democrats, along with the two ranking Republicans of the committee at that time, on a bipartisan basis, sent a letter to President Obama dated January 24th, 2013, objecting to the vacancy and calling for him to fill it. We certainly would love that kind of bipartisanship on IGs from Mr. Jordan and his staff and his office. We have yet to get it.

Ms. Grimm. On Friday, it was reported that a former White House Deputy Chief of Staff, Zack Fuentes, won, on a noncompetitive basis, a $3 million contract to provide respirator masks to the Navajo Nation hospitals into Mexico, days after he registered his company. That is to say 11 days after he created his company. They had no prior experience in providing any kind of medical equipment to anybody, and apparently there are problems with the suitability of the masks, in what is a devastated community, the Native American Reservation community. In this particular case, the Navajo nation. Is your office going to be looking into this no big contract and how it came about to be awarded.

I thank you for that question. Whenever we are made aware of potential improprieties, we would look into that. I cannot confirm the existence of an investigation. We do have work as part of the 14 jobs that I mentioned earlier, looking at the Assistant Secretary for Preparedness and Response Operation of the Strategic National Stockpile for COVID.

Yes, but we talked about waste fraud and abuse. Here is a prime candidate, don’t want to prejudge, but there’s something suspicious about awarding a contract to somebody who has no experience, who formed this company 11 days before the award of the contract and provided unsuitable equipment, reportedly to just a devastated community. The Navajo Nation. It seems to me a prime candidate for your office to look at. And if you need it, certainly I, and I assume the chairwomen, would be glad to write you a letter asking for such an investigation.

Let my group be in contact with you. After this, we’ll get some additional information from you.

Great.

And we will take a look at that issue.

Okay. Great. Does CDC within your purview?

Yes.

Are you going to be looking at the failure of CDC, A, to develop a test at a timely fashion, and B, the catastrophic failure of the test they finally did develop to work? Costing us almost two months instead of using the WHO approved test.

You’re asking about issues related to tests and faulty tests. We don’t have information on that yet. OIG currently has two ongoing reviews that is focusing on HHS’s role in approving and producing test kits. We do have a review specific to your question to look at CDCs process of approving, producing, and distributing the COVID test kits. We also have another review looking at FDA and their emergency use authorizations.

Well, clearly lives were lost because of that failure. And it seems to me, that’s got to be a primary focus of your work so that we don’t repeat that and that hopefully we can learn from those lessons in moving forward with rapid testing and rapid responses, because this pandemic is not over.

Chairman Connolly, We would love to come up and brief you on our work looking at CDC testing.

okay. You’re also going to be looking at the National Stockpile and how well it worked and how we managed it and how we distributed from it, right?

Yes.

Will FEMA be part of that investigation, because FEMA ended up distributing stuff from Stockpile, right?

Our jurisdiction does not currently extend to Homeland Security and to FEMA, but it would examine potential coordination with FEMA. And we’re considering other reviews, and in contact with Homeland security to potentially do something jointly.

I think that’s going to be important, Ms. Grimm, because the stockpile may fall within your purview, but the distributor was FEMA. And you’ve got to be able to get into FEMA to understand, well, how did you make decisions about distribution? I can remember in the first month of the pandemic, my state, Virginia, which is still a hotspot, in Northern Virginia, especially where I live. And the number of new cases and deaths, are still going up here.

And yet when we asked for PPE and other equipment, we got 7% of what we asked for. Meanwhile, as I recall, the state of Mississippi got over 100% of what had happened. So that kind of gap really raises questions about judgment, fairness, equity, or just plain incompetence. But we need some answers about what were the formulas use, and why were certain decisions made or not made? And how can we try to make sure we replace that system with something that’s predictable and equitable and based on needs?

I would hope that you do everything you can to incorporate at least FEMAs distribution role from that stockpile, so we have a better handle on those issues. Because again, lives were at stake and lives were lost because of bad decisions made at that time. I’m seeking reassurance. Ms. Grimm.

I’m sorry, your screen froze, Chairman Connolly.

I’m sorry.

No, no, no. I didn’t know if you were still talking, or not. Yes. I hear your point. I know that there’s a continuity of role issue in looking at both what happens with Asper and with FEMA. And we looking to get answers in coordination. And I will take that issue back and see what we can do.

My final question, if I have time, Madam chairwoman, Chairwoman Maloney and I have written a bill that would prescribe how an IG might be removed, and require more stringent, robust methodology with respect to the end criteria that would have to be met, including documentation. Are you concerned, professionally, that the independence of IGs, or your own independence are at risk, or might be compromised by recent statements and actions taken by the executives?

Chairman Connolly, I would like to address you question by just talking about the importance of independence for inspectors general generally. I view, and the community views, independence and effectiveness of an IG as a key safeguard for the programs that we oversee. It’s a cornerstone of the IG Act, and it is a foundational element of the work of at any IG. It’s what allows us to bring our objective judgment, to bear on problems, without worrying about whether those that run the programs are hearing what they want to hear, or what they want to see the programs be doing. That we follow the facts wherever they lead. We are impartial in what we do. And really anything that is done that could impair independence, I think, compromises the effectiveness of oversight of programs on behalf that are there to serve the American public. In our case, the 300 programs within HHS.

Thank you. And we’ll have your back on that independence. Thank you, Madam Chairwoman. I yield back.

Speaker 1: (57:54)
Thank you, Mr. Connolly. We will now move to Mr. Grothman. Mr. Grothman, you are now unmuted.

Glenn Grothman: (58:02)
Okay. Thank you. You can see me? I have a few questions. And maybe you’ve looked into these and maybe you haven’t. And maybe I’ll just cause you to begin to look at them in the future.

There’ve been a lot of criticisms as far as the government response to this pandemic. My first question is with regard to coming up with cures, or reducing the number of people who get the pandemic, have you looked into the degree to which things like vitamin D, or vitamin C, plus zinc and that sort of thing are being looked at by somebody out there? NIH, CDC, someone?

We are not looking at the effectiveness of treatments per se. I will say on that specific point of vitamin C, we actually have seen quite a bit of fraud in that area with purported cures, using a vitamin C. And other schemes that are really meant to entice beneficiaries, to give their Medicare number in order to steal their identity.

[crosstalk 00:59:20] Vitamin D has been subject to a lot of hope. There’ve been studies at Northwestern, I think Trinity College in Ireland. And some people, there was a criticism of the Department of Health that it’s too much just looking for vaccine, vaccine, vaccine, and not looking at other alternatives done, or suggested by doctors, or academics. Do you do anything as far as auditing as to whether the department of health is looking into these other things? People wonder why they aren’t.

We do not have a work looking at those issues that you have identified.

Glenn Grothman: (01:00:04)
Would you look at then? Given all the money they’ve got, they’ve got, as it’s been mentioned, billions and billions of dollars. It seems strange that academics are out there pushing vitamin D and they’ve been quiet over there with their billions of dollars.

Next question. There’s some questions out there, people write columns. I don’t know what to say about it, that the number of people dying of COVID may be in some areas, high. And that apparently hospitals are reimbursed more if people of the COVID and reimbursed even more, if they get on a ventilator. And there have been criticisms of overusing ventilators, particularly in New York area, is that something you looked into? Does that cause the number of people who’ve been checked off as dying other COVID to be increased? And is there a difference around the country in the degree to which people use ventilators quickly?

Christi Grimm: (01:01:12)
We don’t have any specific work looking at that particular issue. We are very aware that the pandemic poses challenges for all regions of our country, which vary from state to state, county to county and city to city. We are monitoring through our data, accompanying bills and claims with the COVID diagnosis as a way to potentially upcode. And other means by which taking advantage of this pandemic.

Okay. I’ll give you one more question. If you look at state to state, the number of people who die versus the number of people infected, it varies wildly by state. Do you look into why that is? The percentage of people who get it, at least on the statistics were given, compared to the percentage of people who die, varies dramatically. And I wondered if you had looked into that, or would let us know if there’s a reason for that.

Okay. I think what you’re asking is are we looking at the accuracy of the counts of positive tests and then death rate?

Not solely that. Not just the counts, but are people treating it differently in different States? That’s relevant too, right?

We could be looking at that from a data perspective. If it could be helpful, we could come up and brief you on what data we do have and hear more about your concerns and try to figure out if there’s a way from a data perspective that we could be able to get you some information.

Okay. Thank you. I’d like to meet with you sometime. And the point I’m trying to make is that if the protocol in hospitals vary from state to state, maybe that’s one of the reasons why so many more people are dying per case in some states than others. It’s not like a 10 or 20%, or it’s like a over twice as much, or three times as much more. There’s something wrong with these numbers, but I’d love to meet with you. Thank you very much.

You’re welcome.

Speaker 1: (01:03:33)
Thank you. Next, we will go to Ms. Norton. Ms. Norton, you are now unmuted.

Eleanor Holmes Norton: (01:03:40)
Oh, thank you very much. I hope you can see me and hear me. I want to thank our chair for holding this briefing and particularly do I want to thank Ms. Grimm, because it’s been very informative. And you’ve already answered a number of questions that I would have. I have a very specific question that has been troubling me. I know that you say you have done 14 reviews. And the word review is the operative word for what the inspector generals do. They look at what has occurred, they evaluate it. On the basis of that evaluation, we learn what to do the next time.

Rarely do you have an as a opportunity for a real time review. Memorial Day caused many jurisdictions to open to various degree. My own jurisdiction, the District of Columbia was not one of them. In fact, it has not opened at all. But it has postponed the opening based on the CDC guidelines of a very narrow, as I understand it, a very narrow reopening until Friday and is looking, of course, at the effects of the virus before doing it.

In effect, Ms. Grimm, what you have is a real time experiment going on. Huge differences based on decisions to reopen now occurring in 50 states. I’m asking more as an academic question, you haven’t been asked to do this, but given your expertise would not it be useful to take a period in time, let us say a one month period, during which these reopenings occurred, to analyze in real time what the effect has been, so as to inform us about reopenings in the future.

I recognize you have to narrow it down to certain kinds of elements. But I’m asking now that you have this real time experiment going on, because this is an unprecedented matter and people didn’t know what to do, except to abide by the CDC guidelines. The president has already indicated that he thinks people should go ahead and reopen, but we don’t have any guidance. And I’m asking you whether it would be appropriate given that we are the committee on oversight, to seek some guidance being on what amounts to a real time experiment as jurisdictions reopen.

Thank you for your question, Congresswoman Norton. We do not have work that is looking at the effects of reopening. I will note that Johns Hopkins website does identify new cases and deaths every day. And that information is largely available to the public. We do not have any work in that space right now.

I understand you don’t have any work. As I indicated, I’m wondering whether there is any way to take advantage of what amounts to…

Ms. Norton: (01:08:03)
There is any way to take advantage of what amounts to a realtime experiment. It’s not as though jurisdictions are opening for just any reason, they’re under a lot of pressure to open. And we don’t know what the effect of that pressure, that’s why I’m asking as a scientific matter, not because you have been asked to do it, but because of your own expertise, whether there would be any advantage in taking advantage of this period in order, for example, and I gave as an example one month, to see whether or not the reopenings matter according to when they occur.

I do think that there would be value in seeing what the effects across different states and conditions would look like. We do not have plans at this moment to do that work.

Ms. Norton: (01:09:13)
Thank you very much. And I want to say to Chairwoman Maloney that I think this is too ripe an opportunity for us not to take advantage of. As a committee on oversight, with nothing left but the frustration of the American people, with reopenings occurring in all 50 states and [inaudible 01:09:38] and the District of Columbia to various degrees, with no data to know from hindsight whether reopenings matter or not, I’m asking the Chair to look into whether or not there would be a way for the committee to take advantage of this period of reopenings across the board, regardless of CDC guidelines, to learn from for the future. And I thank you, Madam Chair, for this opportunity.

Speaker 2: (01:10:14)
Thank you, Ms. Norton. We will now go to Mr. Comer. Mr. Comer, you are now unmuted.

Representative Comer: (01:10:29)
All right. Well, thank you. And I have three questions, but before I begin, I want to echo what Jim Jordan said. I feel that this committee hearing should be held in Washington. I think it reflects very poorly on the United States House of Representatives that we are not currently in Washington right now, especially considering that the US Senate is and has been for several weeks. And we have to focus on reopening our economy. America cannot afford to be shut down unnecessarily much longer. And Congress should be leading. But instead, because of Speaker Pelosi and House Democrat leadership, Congress continues to stay holed up. And that’s not leading by example, especially when you consider that many, many Americans never did stop working. We had essential workers and not just in the healthcare occupation, but also in many industries across America never stopped working. But Congress is still holed up in their homes because of the decision of Speaker Pelosi. And I think that’s terrible. I think that sets a terrible precedent. And I’m getting more upset about it each day.

Now I want to begin with my questions for Ms. Grimm. Ms. Grimm, in your report, you said there was a widespread shortage of PPE. According to a recent Homeland Security report, China had been limiting the export of PPE and purchasing large quantities of PPE for months while hiding the severity of the pandemic. It seems clear now that a significant cause of the shortages was China’s efforts to cause our PPE shortage. Has your office considered analyzing China’s efforts to limit exports and purchase substantial quantities PPE?

We thank you for your question, Representative Comer. We do not have work currently looking at this. And a key reason is that the CARES Act directs the Department of Health and Human Services to enter into an agreement with the National Academies of Science, Engineering, and Medicine to evaluate US dependence on critical drugs and devices that are sourced or manufactured outside of the US. And in that legislation, it says that it may include analysis of the supply chain of critical drugs. So at this moment, we do not have work in that exact space. We do have work that is ongoing looking at foreign inspections of drugs.

Okay. The President had already been working with the private sector to manufacture more PPE nearly a month prior to your report’s release. Why did you not include the ongoing efforts by the administration to address the PPE shortage caused by China?

Thank you for that question. So the report used was really designed to be a quick snapshot of what was happening on the ground in hospitals. And we interviewed hospital administrators. Again, we had an 85% response rate. It was based on a prior survey methodology that was used for an Ebola response. And yeah, the only entity that we did interview for that report, and I will note that that report started, the start notice was issued on March 23rd, we had a report out on April 6th. And it is my understanding that this committee and others are looking for a rapid response infer region with which to make decisions. So we made choices in being able to provide quick turnaround information on the perspectives of hospitals.

Okay. My last question, there’ve been numerous public stories that the Chinese government hid the severity of the pandemic early on and the World Health Organization enabled them to do so. Did the delay in understanding the severity of the pandemic cause a delay in the administration’s ability to respond?

We do not have current work looking at that. That would fall into that general idea of response and timing. Now, we believe, is not the time to be looking at issues like that. That falls into our effectiveness category. So our strategy, as I articulated earlier, protect people, protect funds, protect infrastructure, and ensure effectiveness. So we’ll look back at some of the decisions and what actions were taken as a result of information. That would be something that we would potentially consider down the road.

Well, hopefully Congress will get back to Washington and get back to work so that we can start to begin taking steps to limit our dependence on China for PPE and vaccines and all sorts of essential self care products that are currently manufactured in China that we would like to see begin manufacturing in the United States. Madam Chair, I yield back.

Speaker 2: (01:15:57)
Thank you. Next we will go to Mr. Raskin. Mr. Raskin, you are now unmuted.

If there’s a question being asked or a statement being made, I cannot hear it.

Speaker 2: (01:16:43)
Okay. I think Mr. Raskin is having some technical difficulties. So we are going to move to Mr. Sarbanes for now. Mr. Sarbanes, you are now unmuted.

Mr. Sarbanes: (01:16:54)
Ms. Grimm, can you hear me?

Yes.

Excellent. So I found this description of Inspector General’s, which I just wanted to read real quickly. A US Federal Inspector General is the head of an independent nonpartisan organization established within each executive branch agency assigned to audit the agency’s operation in order to discover and investigate cases of misconduct, fraud, and abuse, and other abuse of government procedures occurring within the agency. And I just read that because, frankly, I don’t know that a lot of members of the public actually know what an Inspector General does, but also because that description emphasizes a point that you’ve made and that a lot of my colleagues have made, which is how critical the independence of your work is to the result we seek and that you’re really acting on behalf of the public when you conduct that. And that’s why these protections that we’ve talked about in terms of how the Inspector Generals operate, how, in this instance, you operate, that you’re able to maintain that independence, be protected against retaliation and other sort of political maneuvers. So we’re going to continue as a committee to insist on your independence. And we thank you for carrying out your job with that particular mission in mind.

I did want to talk a little bit about process because it’s really important for us as committee members to make sure our expectations of what you can do and how quickly you can do it is in line with sort of what’s possible and the reality of it. So obviously, you have categories of review within HHS, whether it’s the Strategic National Stockpile or it’s nursing home shortages of PPE, how hospital dollars of being distributed, whether that’s being done properly. Can you tell me real quick, how much of the broad base review that you undertake is tied to sort of an initial work plan that you draw up ahead of time, and how much is it in response to issues that come up, specific issues that get raised? And that, I guess, could happen through press accounts of things that are going on, whistle blower complaints that may get filed, issues that members of Congress bring up. Can you tell us kind of how you allocate your time and focus between those two baskets of response?

Thank you for your question, Representative Sarbanes. I think you’re very well informed in the various ways that information might come to us. All of the above is the way that I would answer that question in terms of the way accounts or possible issues might come to us. We hug closely to the requirements for the funding that we get. About 80% of our work is to look at Medicare and Medicaid. And the other 20% is to look at some of the issues that are basically outside of the Centers for Medicare and Medicaid services. Of course, if we’re made aware of an issue, for instance, of abuse and neglect in a nursing home that we see in a newspaper, we would follow up on that appropriately. We consider input, of course, from Congress, congressional requests from the department as a result of the reports that we do and issues that we find and following up on them.

So there are a variety of ways that we come to an idea. We have an incredibly rigorous work planning process. We, on a weekly basis, bring together what I refer to as our sort of board of directors here in OIG, which is a multidisciplinary team that consists of our Head of Investigations, our Head of Audit, our Head of Evaluation and Inspections, our management and policy team, and our data experts to deliberate on possible ideas, whether it would be a good investment for OIG, the opportunity cost for doing one thing versus another. As you know, we have south of $400 million in order to oversee. Now with the CARES Act, close to $2.5 trillion. So we do have to make choices with the kind of work that we do. You raised another issue-

Yeah. Let me ask you a question. So let’s just take the example of some hot topic. Something comes up, there’s been a news story, and members of Congress are concerned about it. We flag it. I assume the method is that we bring it to the Committee of Jurisdiction. In this case, the Committee on Oversight and Reform. The committee translates its interest in having you address this issue of whatever that hot topic is. What happens then in terms of your ability to respond? And then when you do generate observations about this or findings, and what’s the fastest time frame one could expect that that kind of, and obviously it will vary, but err on the fastest way you could turn around something on a very specific concrete issue.

And then when you generate your findings inside, where does that go? What’s kind of the chain of command for reporting that up and then out to the party that originally inquired, in this case, a committee? Because I think it goes to the independence question. We’re very nervous, based on things we’ve seen over the last couple of months, that there will be undue pressure, influence, et cetera, exerted. So I’d like to know how do you respond to a hot topic? How do you generate your observations? Where does that go, as it were, internally within your agency, before it can then come to us? And what’s the fastest time frame we could expect? And with that, I’ll yield back once you answer that question.

I would be hard pressed to identify a faster product than the hospital preparedness report. That was one of our sort of faster products. Other examples of fast turnaround products include fraud alerts, early alerts. If we’re finding immediate jeopardy during the course of our review like looking at nursing homes, we would alert the public. Well, actually we always alert the department before we release a report to the public. We have data briefs on things like opioid use. And in some instances, we release sort of our formula for how we do our work so that other states can learn from it. And an example there is our sort of tool kit on opioids, which we have released broadly for other states, for instance, to use.

The process. When we have a report in draft, if it has recommendations, we are required to get input from the department that we oversee for recommendations. And so we, of course, do that. That takes time to do. We consider input on our recommendations. And we typically ask 30 days for a response to our reports. Sometimes it’s faster that we ask for comments. And then we have a very sort of arduous review process internally to make sure that we are adhering to our professional standards and that the quality standards are met before it is released. So the turnaround products that I mentioned, fraud alerts, early alerts, poll survey, data brief, and tool kits, those could be some of the faster turnaround products. I know this committee in particular is interested in flash reports. I have to say that it depends on the topic, it depends on the data, it depends on the availability of staff. If you’re asking to do an onsite survey of nursing homes, which is something that we’re doing as part of our coronavirus response work, that takes time. And we need to make sure always that we meet our professional standards of conduct before we publish a report. I hope that answers your question.

Speaker 2: (01:25:49)
Thank you. Next, we will go to Ms. Miller. Ms. Miller, you are now unmuted.

Congresswoman Miller: (01:25:55)
Thank you. And thank you, Chairman Maloney. And thank you, Ms. Grimm, for being here today. I do want to echo my colleagues frustration on how we are conducting business. I think we belong in Washington, DC. We were elected to be in Washington DC. And I think we should do a better job. We can figure out how to have these committee meetings. I also think that we can all agree that we have taken the response to the pandemic almost on an hour by hour and day to day basis. Situations on the ground can change very rapidly, in a matter of minutes almost. And our first responders and our medical centers have learned to evolve rapidly.

This report was released at the beginning of April and its findings were sourced at the end of March. There’s been a significant amount of improvements that have occurred since this survey and the reports released. We drastically increased our production of PPE through the Defense Production Act. And quite frankly, the American people have risen to the occasion. Many of my colleagues have situations in their own districts where companies have stepped forward and are producing things to help us through. Ms. Grimm, are you doing appropriate comparisons of the data that you have in the same type of time frame that you’ve picked this first batch to put it in perspective? This is just a snapshot.

Correct. It is just a snapshot. And I appreciate your question, Congresswoman Miller. I acknowledged at the beginning of the briefing that the department has done a great deal to address the issues that were raised in the hospital preparedness report. Steps to address protective equipment, ventilator shortages, including by entering into contracts under the Defense Production Act. They’ve also addressed hospitals’ financial shortcomings by approving advanced payments to Medicare providers and distributing relief funding. There has been a tremendous amount that has been done since that snapshot report March 23rd through March 27th.

I just feel like it would be a fairer comparison if you did use the same data requirements. And if you’re doing it every two weeks, to show how we have improved as we’ve gone along, because, I mean, this pandemic, none of us have had this kind of experience before. And to see how we have improved, anytime you do any kind of action or any production that is brand new, at the end, a company or a government, you look over what you’ve done and you go through the woulda, coulda, shouldas as you go forward. But you also notice what you did well, what you didn’t do well, and how you can improve. Do you think the administration has taken actions to increase testing capabilities?

We don’t have work looking at tests. We don’t have work looking at increases in testing capabilities, the supply chain of testing. So it would be challenging for me to speak to that authoritatively. What I will say in response to your question, my briefing today, I am desiring to talk about our 14 ongoing COVID reviews. We have work looking at how funding is … What oversight is happening with funding. We do have work looking at testing, at CDC’s process of approving, producing, and distributing COVID test kits, the review of FDA’s emergency use authorization. We have work looking at nursing homes, life and safety issues in nursing homes, how they have responded in terms of the safety protocols that they put in place, work looking at the stockpile. And we do have follow up work looking at CMS. It’s not follow up work, but work on hospital preparedness, looking at CMS’s internal controls over hospital preparedness.

The report that we did on March 23rd through the 27th that was published on April 6th was the right report to do at the time given where we were at. We do not have that exact methodology happening looking at hospitals as follow up. We have other work that we have moved on to do. But I acknowledge the department has taken steps to address a lot of the issues that were raised in our report.

And I think that’s fair. In my town of 50,000 people, we had free testing this past weekend, and I know the health department was disappointed. The first day, only 600 people showed up for free testing. So we’re all learning as we go on. And I appreciate what you’re doing and I think we just need to be fair and continue to get better at what we’re doing. I yield back my time. Thank you.

Speaker 2: (01:31:33)
Thank you, Ms. Miller. Next, we will go to Mr. Raskin. Mr. Raskin, you are unmuted.

Mr. Raskin: (01:31:41)
Thank you very much. Ms. Grimm, thank you for your report and your presentation. It’s May 26th and we have now lost nearly 100,000 Americans in this pandemic crisis, more Americans than we lost in the Vietnam War, the Iraq War, and the Afghan War combined. We have 38 million Americans thrown out of work, unemployed right now, as a result of this crisis. A million and a half of our people have contracted the disease at some point. And the numbers might be as much as double that because so many people have not been tested who actually ended up getting it. I can only regard with amazement some of the self righteousness of some of our colleagues. When Obama was President, we had a pandemic crisis with the Ebola crisis and we lost two Americans, two Americans. So this crisis now under President Trump is 50,000 times worse than what we saw under the Ebola crisis.

Mr. Raskin: (01:32:53)
Now, in your report, Ms. Grimm, you canvas hospitals. And I just want to go over the major findings to make sure I understand them. First, the hospitals reported severe shortages of testing supplies and extended waiting periods for test results. Is that right?

Hospitals reported their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe from infection.

Mr. Raskin: (01:33:26)
Okay. I mean, I’m just quoting from the report that there were severe shortages of testing supplies and extended wait for test results. I see widespread shortages of PPE, difficulty maintaining adequate staffing and support staff, difficulty maintaining hospital capacity, shortages of critical supplies, materials, and logistics, support siding, IV therapy poles, medical gowns, linens, toilet paper, cleaning supplies, and so on. Now, did you make any conclusions as to why they were experiencing these chronic shortages, these severe shortages, in the materials they needed to respond to the crisis?

No, we asked what their challenges were. We asked how they were dealing with it. And we asked what they needed for assistance, for federal assistance.

Mr. Raskin: (01:34:24)
Gotcha. So you had a limited scope there. So are you going to look into the question of whether the HHS or CDC have actually been directing the allocation of these resources? Are you going to look at a question of how the supply chain is broken down?

We don’t have work at this moment looking at supply chain issues, while we do have work that is going to be looking at an audit of the Assistant Secretary for Preparedness and Response Operation of the Strategic National Stockpile. So we are looking at that aspect.

Mr. Raskin: (01:35:01)
Okay. So in your survey, the hospitals, in addition to obviously they’re wanting the government to meet these severe chronic shortages across the board of the materials they need, you also found that the hospitals, and I’m quoting here, wanted government to provide evidence based guidance to provide reliable predictive models to help them prepare for the crisis and to prohibit, or rather, and to provide a single place to find the information they need, like a centralized repository of information. That little fact just jumped off the page for me. In other words, there’s no single place where the hospitals can even go to find out about any of these issues, about either what the best public health science advice is, what the guidance from the government is, or how to break through the complexities of the supply chain?

We did report that that’s what hospitals we’re telling us. And if there’s generally one outstanding recommendation related to emerging infectious disease, it does touch on the need for coordinated guidance.

Mr. Raskin: (01:36:16)
Yeah. Yeah. Well, look, I’m assuming, because there was nothing in the report about it, but I will ask you, whether any of the hospitals were complaining about the Chinese government interfering with their ability to obtain the supplies that they wanted. It seems like some of our colleagues want to try to now point the finger at China, which is fascinating to me because I count at least 37 different statements by President Trump in January, February, March, and April praising the Chinese government and defending the performance of General Xi here. So there’s a lots of fault with China’s performance in this matter, especially their suppression of the truth early on and the doctor who was trying to blow the whistle, but President Trump seemed to be defending them and praising their conduct from the beginning. But I’m just wondering, did any of these hospitals actually complain about the Chinese government’s inability to provide them with the materials and the equipment that they need?

Not that I am aware of.

Mr. Raskin: (01:37:22)
Okay. Well, I just want to say that the hospitals in my district like Holy Cross Hospital in Silver Spring, which I spoke with, have been complaining precisely of all of the things that the hospitals you spoke with are complaining about, the severe shortages of testing supplies, the erratic and inadequate supply chain, the difficulty maintaining adequate staffing, and so on. Is there any reason to think that any of these hospitals were lying to you?

No, I do not believe the hospitals were being misleading in providing us with this information.

Mr. Raskin: (01:37:56)
And has anybody questioned the veracity of their statements to you?

There have been generally voiced concerns about the veracity of the findings, but we did not independently go behind and verify, but that’s the detail that was provided to us by hospitals.

Mr. Raskin: (01:38:19)
Well, thank you for your hard work and I yield back, Madam Chair.

Speaker 2: (01:38:22)
Thank you, Mr. Raskin. As a reminder, and to ensure all members have a chance to ask their questions, members are asked to adhere to the five minute question limit, please. Next we will have Mr. Keller. Mr. Keller, you are now unmuted.

Mr. Keller: (01:38:39)
Thank you, Madam Chair. I’m disappointed that we have not resumed normal committee activities in person and under proper protocols. Congress has proven it can do business in person with proper social distancing and hygienic measures. Several house committees have held in person hearings during this pandemic, and COVID-19 should not be an excuse as an abdication of our responsibilities in removing minority party rights, but that is just what majority has done. These briefings have become nothing more than a way to skip normal order, cut Republican members out of the process, and further politicize a pandemic that we should be all working together to stop. I would just say that while I appreciate Ms. Grimm being with us virtually, she has not been sworn in to give her testimony. I hope to have committee business done in person following committee rules with sworn in witnesses going forward.

Mr. Keller: (01:39:34)
The one question I would ask is when I hear people talking about, it was early, I think it was Chairman Connolly was saying about the amount of material that was asked for, and then what the percentage of it they received. Like they asked for so much and they only got 80%. And some asked for so much and got 110%. What did they actually need? And I think that’s what we should be focused on, not what somebody asks for, but do they actually get? Governor Cuomo asked for a lot of things, but turns out he didn’t need that. So are we planning on, when we look at how things are allocated, looking, did everybody get what they needed to take care of the people they have? And did some people just request more than what was required? Is there any plans to actually look at how the needs were met without putting other areas in jeopardy by not having supplies available?

Thank you for your question, Representative Huffman. It is a good question to think about what existed at the ground level and what needed and what was actually done with that supply. And we are looking. It’s not something that would be able to be done very quickly, but we are looking at something that could be a comprehensive view later on down the road of tip to tail what happened from the federal down to the local level, which could include an examination of supplies and use of supplies.

Mr. Keller: (01:41:09)
Yeah, because if you look at what happened, and we did everything we should have, but things were requested, and I’ll say in New York, and were deployed to New York, but they didn’t need them all. And then the governor there said, well, they just sent them elsewhere. I don’t think we need that middleman to send them elsewhere. Deploy what needs to be deployed to the areas they need to go and manage that supply chain. That’s supply chain management. And I think being what Representative Jordan said, did we meet the original goal of what we did with our shutdown, making sure that our healthcare system could provide what it needed to provide? We actually met that goal, didn’t we? Healthcare system America did not collapse under this because we met the goal, correct? Like it did in other nations.

I cannot comment on that and we do not have work on that. I will say-

A comment on that. And we do not have work on that. I will say, between March 23rd and March 27th, we, in talking top hospitals, identified extreme shortages, which was reported in the report.

Fred Keller: (01:42:16)
But everybody that needed a ventilator got a ventilator, everybody that needed care got care at our hospitals?

On the topic of ventilators, we did not for that time period, identify any hospital who told us that they were experiencing is in rendering ventilator care, but were expecting to have a shortages down the road.

Were any hospitals unable to provide care for people with COVID-19 that you interviewed?

We did not ask that question specifically, but they did report to us that they were treating patients. A lot of them as presumptive positive, which had downstream effects on bed, on staff, on supplies, because of shortages related to testing.

Did any hospitals run out of beds or places if they needed to hospitalized somebody for COVID-19?

I don’t have that answer at the tip of my fingers.

So we’re not aware of anybody that needed care that didn’t get it?

We did not ask that question in that way.

Well, if we’re trying to find out how we did as an agency to provide care for American citizens and people that might have COVID-19, wouldn’t they be good questions to ask?

So again, that report was meant to be a quick turnaround products. We asked three questions. What challenges are you experiencing? What are your mitigation strategies, and what do you need?

I yield back.

Speaker 3: (01:43:59)
Thank you, Mr. Keller. Next. We will go to Ms. Speier.

Jackie Speier: (01:44:06)
Thank you. You can hear me?

Yes.

Can you see me?

No.

You can’t see me. Okay. Let me see if I can get this. Is it working now?

No, I still can’t see you. Now I can see you.

Now you can? All right. Let me just start off by saying this, Madam Chair, I applaud you for holding this briefing hearing. I think that it is as good as any briefing or hearing we would have in the Capitol itself.

The 21st century as required fortune 500 companies to look at whether or not they could work remotely, and they have been thrilled to find out that they can. So I would like to associate myself with all those who feel that by working remotely, we still are doing our jobs. In fact, maybe doing our jobs even more directly with our communities. I know my staff and I have been working to get PPE for our hospitals, sourcing them from all over the place, and also getting the PPP loans for our small businesses. So thank you for doing this. This is as good as it gets.

Let me move on to ask Inspector General Grimm a question. On March 23rd to 27th, you did this snapshot survey. You then reported it on April 3rd and shortly thereafter, the president of the United States was asked about it and he said it was phony, that it was fake; wasn’t true. And then on May 1st, he decided to appoint a new inspector general.

I am concerned about the independence moving forward of inspector generals, if they feel they cannot provide any bad news without fearing that they’re going to lose their job. Can you comment on that?

A couple of points that were raised there. We have been preparing for an inspector general since the last presidentially appointed Senate confirmed inspector general retired in June of 2019. So putting that out there, I do think that independence is the cornerstone of what any office of inspector general does, and that allows us to be impartial in the work that we do, and to go right down the middle, in providing facts and letting those facts take us where they may. And it is a critically important element of any office of inspector general.

All right. So you don’t think there’s a chilling effect if you say something or do something that is offensive to the president, that you will be removed from office?

No, I personally and professionally cannot let the idea of providing unpopular information, drive decision making in the work that we do. And I think today, I hope members are hearing that the 14 jobs that we have planned to protect people, to protect funds, to protect infrastructure, and to ensure effectiveness, we are operating as we did on May 1st. We are plowing ahead.

Okay, let me move forward with an issue area. We’ve had 118,000 residents and staff at nursing homes that have been infected and 19,600 who have died. That’s almost 20% of those who have died from the coronavirus. I understand you have new planned work items regarding nursing homes. I’m interested in knowing whether or not you are going to look at the difference between for profit nursing homes and nonprofit nursing homes. Because it appears that the for-profit nursing homes were less prepared for the pandemic than the not for profit ones.

It’s a very interesting question. We do have several jobs that are related to nursing homes and the idea of ownership, and whether it’s for profit or not for profit, is frequently a consideration in our work, as is rural and non rural. So I will take that question back and we will get back to you on whether or not it’s already baked into our work. I wouldn’t be surprised that it is, because we do often consider that issue.

I would also ask that you look at PPE. In my district, PPE for nursing homes was totally nil. But for the county providing some, there would not have been any. Furthermore, board and care facilities and independent and assisted living facilities, come under no review or regulation whatsoever. And I hope that you will at least contemplate that in your work as well.

Finally, one last question, the issue of ventilators. We have about 160,000 ventilators I’m told, and I’m also told that we must maintain that number in order to be prepared for waves of the pandemic occurring later this summer into the fall.

The president has just announced to the Congress that he is going to convey as a gift to the Russian people and to Vladimir Putin, $5 million worth of ventilators. Are you able to make any kind of a snapshot survey of the same hospitals that you surveyed back in March to find out whether or not the reduction of $5 million worth of ventilators will have an impact on them?

Thank you for that question. We do not have plans to repeat that same survey. We’re exploring that same methodology in talking to laboratories, and for ventilators, again, I think the closest piece of work that we have is the audit looking at the strategic national stockpile, but that’s the work that we have ongoing.

I would also point you to, you mentioned independent living facilities as part of our health and safety audits, we are considering work, we’re doing work that is looking at adult day centers and individual supported living facilities. We are looking at life and safety issues and whether or not they’re controlling for emerging infectious diseases. We recognize that that is an incredibly vulnerable population and that is a top priority for us.

Great. Thank you very much. I yield back, Madam Chair.

Speaker 3: (01:51:28)
Thank you. Next, we will go to Ms. Plaskett Ms. Plaskett, you are now unmuted.

Stacey Plaskett: (01:51:38)
Thank you. Can you hear me at this time?

Yes.

Hi, good morning. Thanks for taking some … There’s been a lot of questions and a lot of information has been conveyed about how the country is responding to this virus and the support that’s being given to hospitals and throughout the nation.

I’m concerned about those hospitals that are very rural. And while we have seen an immediate request for PPEs and ventilators in those areas that are more metropolitan, are you all keeping aside those things that you believe will be necessary if there is an increase, or if the numbers increase in areas that we have not seen already in the United States?

Well, OIG does recognize that the pandemic presents challenges for all regions, but it does vary from state to state, county to county, and city to city. And issues related to urban and rural, we are looking at how some of the expanded capabilities that CMS is allowing, including tele-health have sort of impacted patient care, in particular for rural areas, looking at audio only telecare. And we’re, as I said earlier, mindful of urban and rural issues in a lot of the work that we plan and that we do.

So I’m of course, going to bring it home to the Virgin Islands, where we’re concerned, of course, if we should have a surge in cases or there’d be a second way, our department of health and our governor have done a good job in making sure that there’s been sufficient social distancing, taking care of our elders. So we’ve not seen a large number of cases.

However, with the reopening and people traveling, potentially our hotels reopening, many of us have a concern that we might get another wave and much larger. And with a hospital that is enormously very small and has been compromised because of the 2017 storms, of course, that concern becomes real. I mean, we don’t have sufficient hospital beds in normal circumstances right now.

Are you all, or have you seen accountability taken into that for areas like of the Virgin Islands to be able to receive their portions of the funding that’s being provided to build out hospital beds, to the army corps of engineers and others. The notion of us having to pay a cost share of that makes it much more untenable. There’s a concern that should we have to do that, we’re not going to be able to make that cost. Have you all looked at that? And have you done any studies to determine if cost share waivers should be given for those kinds of necessities?

So we are doing an audit of CARES Act for Provider Relief Funds, the distribution of the $50 billion to healthcare providers and whether or not those calculations were calculated correctly and funds distributed appropriately. So we are looking at that.

I will tell you, as you may know from the snapshot report, the 23rd through the 27th, we did hear from rural hospitals, their concerns about not being able to meet patient care needs. There was a quote in the report that there’s no mothership there to come and save them. So we are aware of those issues and we also have some work, which I neglected to mention a minute ago, conducting compliance related oversight. Oh, I’m sorry. I just mentioned that, I apologize. The compliance related to oversight in the payments, the Provider Relief Fund, we are looking at that, which would touch on some rural issues.

Great. So with that discussion and the cost share, can I ask, so you’re aware, certain hospitals in the United States, including children’s hospitals, cancer, hospitals, rural hospitals and those located in the territories, continue to be paid by Medicare solely under a reasonable cost based system. That predates the Medicare hospitals Inpatient Prospective Payment System, the IPPS established in 1982, or what we know as TEFRA.

So TEFRA hospitals like the Virgin Islands, were uneligible for outlier payments under the CARES Act. And this is an IPPS add on payment for COVID-19 patients during an emergency period. However, if a TEFRA hospitals inpatient operating costs exceeded ceiling, hospitals paid under TEFRA may request a payment adjustment for those costs.

Both U.S. Virgin Islands hospitals reimbursements are based on years 1982 and 1996, where those re-basings were done respectably after major hurricanes. And both of our hospitals have requested a new base here because current cost of inpatient care at both hospitals are not comparable to the cost during those base years of 1982 and 1996. Do you know what that status for that request is? And will the cost, should there be and increase or a surge in COVID cases, make that more untenable for us?

I do not have any information on the status of that. Our work generally as an oversight entity, because we don’t administer the program, would be to look at whether rules are being followed, whether there are inefficiencies potentially in the way reimbursement might be structured. But we do not generate those policies, we audit or evaluate against existing rules.

So would you then be able to do an audit to determine if those base years that we have are in keeping with the costs of what’s happening, of inpatient costs in the Virgin Islands now?

I think that we can take that issue back certainly to our auditors to see if there is work that relates to that specific issue and potentially sit down with you.

Okay, well, we’ll follow up. Thank you. I have no further questions.

Speaker 3: (01:58:46)
Thank you, Ms. Plaskett. Next, we will go to Ms. Tlaib.

Rashida Tlaib: (01:58:51)
Oh, thank you so much. I don’t know if folks can hear me. I really appreciate this. Thank you to Chairwoman Maloney for this as well. I want to center a lot of what we’re doing. We always talk about review and oversight, but I think it’s really important to bring our districts in the room and the people that are outside of the halls of Congress. I just want you all to know, as of two days ago, I know my city, city of Detroit, I had over 10,000 cases and over 1300 deaths. Wayne County alone, outside of the city of Detroit, which is the largest County in the state of Michigan had over 9,000 cases and just over 1000 deaths.

I say that because I remember being in Committee and asking Dr. Fauci, if there was going to be 1.5 million people that are going to contract COVID, he said, “I don’t know where you got that information, that’s not true.” I think we’ve surpassed 1.3 million now. And again, I want to center this and why oversight is so critically important. And we can do this in a way that it keeps us all safe, because like me, like many of you are mothers caretakers of your elderly parents and others. So we can be able to do the job that our folks sent us to in this way and do it very effectively.

The question I have for you, Inspector General, is one of the things that’s happened with HHS’s distribution, they called it the Provider Relief Fund, is that HHS reported that it distributed $50 billion to facilities and providers across the country, based on their prior Medicare reimbursements and share of net patient revenue. When we took a deeper dive in my district on this particular issue, HHS had distributed about 30 billion in the first batch of public health and social services emergency fund. However, my district Michigan’s 13th congressional district, which is the third poorest congressional district in the country, received least amount of funds of any Michigan congressional district. My district received 27 million compared to up to 138 million and other Michigan districts, which are much more wealthier, have some of the largest hospital headquartered and so forth.

And again, looking at my district and seeing again, having, I think the youngest person to die from COVID is a five year old girl in my district. I just really would love for you to explain Ms. Grimm to me, how does the hardest hit district in Michigan and one of the hardest hit in the country can receive the least amount of funds of any congressional district in the state? And I have a follow up question, if I may.

Thank you for your question Representative Tlaib. I know your state has been particularly hard hit by the COVID epidemic and very, very mindful of locations and providers that have been hardest hit by the epidemic. And we have done our level best to make sure that we are meeting providers in communities where they’re at.

For the audit that we are doing for the Provider Relief Funds, we are looking at whether rules were followed in the calculations and whether they were distributed according to those rules. We are not second guessing how those formulas were arrived at as part of the work that we are doing.

Shouldn’t the HHS ID evaluate the substance of the method that was used, that favored some of the larger wealthier hospitals? My staff had sent me and showed me some of the most wealthiest for profit corporate kind of really centered led hospitals got 50 billion compared to some of the smaller hospitals I have in my district, again, that are again, some of the hardest hit. Are we going to be looking at the method of which, from wealthy hospitals while the smaller hospitals with less reserves to fall back on, continue to struggle?

We don’t have work on that right now. I think that could be an issue that would fall under potentially our effectiveness category. And why don’t I have our team come up and talk to you about some of the issues and just hear what some of our authorities and jurisdictions are?

No, I would really appreciate that. And I just want folks to know too, I hear people saying some of the hospitals are struggling now, the ranking member talked about that. But I want you all to know this is a pandemic, a global pandemic people are dying at such a huge rate, past even with the Vietnam War, our lost of loved ones then. And hospitals are closing, they’re struggling, when we have some of the sickest people right now around the country.

That tells you that something’s wrong with our healthcare system. Not to blame whether or not we were doing the best job we couldn’t with uncertain times, and the fact that we didn’t know enough about, and we still don’t know enough about COVID. But to say that it was because the economy shut down because we did it, no. It’s because we were not prepared for this pandemic, nor did we even have a healthcare system that …

And Inspector General, this is not towards you. This is just towards my colleagues, but these theories that I just really want to push back against. My God, the sickest people, we’ve had so many deaths and healthcare providers and hospitals are struggling. That tells you that we have a broken healthcare system. We should be looking at that specifically, versus waiting and trying to point blame at folks where I don’t think any of us wanted to see this many people die or to see any of our hospitals or anybody struggle right now. So thank you so much again, to the chairwoman for holding this hearing.

Speaker 3: (02:04:46)
Thank you, Ms. Tlaib. Next, we will go to Ms. Porter. Ms. Porter, you are now unmuted?

Katie Porter: (02:04:53)
Thank you so much, Ms. Grimm, for taking the time to be with the Committee today. On May 13th, I sent you a letter raising serious concerns about apparent instances of political leadership at BARDA, specifically about Dr. Kadlec, allowing large pharmaceutical companies lobbyists opinions, to carry more weight than those of our nation’s leading scientists. I got your response back on Friday that you are not able to discuss any potential whistleblower complaints. And I understand that, and I respect the HHS IG process. That being said, I don’t believe that some of the questions can wait or that they necessarily hinge on Dr. Bright’s whistleblower complaint alone. So I want to focus on just one of these questions today, which I think still gets at the heart of the concern that I raised.

Dr. Kadlec, the Assistant Secretary for Preparedness and Response, has started new programs to provide funding streams and opportunities for companies to fuel innovation. These initiatives such as ASPR Next, the Division of Research Innovation and Ventures Drive, were intended to lower the barriers for entry for companies and to increase access to funding.

But there’s evidence that they’ve become nothing more than a funding stream for companies that can’t get funds under the previously long established process. This means that our taxpayer dollars may be wasted on projects with little scientific evidence, but that have great lobbyists. Has HHS OIG conducted a review of new projects, such as Drive E and Asper Next for improper industry or political influence? And if not, would HHS OIG agree to do so?

Thank you, Congresswoman Porter. I am familiar with your letter. I signed the response letter on Friday. As I stated in that letter, we are unable to confirm or deny the existence of any investigation and that we do not discuss whistleblower retaliation matters. In response to your larger issue, we do have work that we are discussing internally now, that has not been announced, that we’re still deliberating over. So sort of in the pipeline for deliberation, looking at award procedures for research and development contracts from FY 2017 through May, 2020 using the BARDA appropriations. And I think [crosstalk 00:25:33].

Wonderful. So that’s on the list of potential projects that you’re taking to your team to discuss.

Correct.

And so how would the American public learn of when a decision and this Committee, how would be best learn of what you’ve decided to proceed with for an investigation and the potential scope? Would that go on that list of the 14 projects that you described earlier in this hearing?

So I want to be careful with the language. I would not characterize the 14 possible reports that we’re doing, the jobs that we’re doing, as investigations. Those would be audits or evaluations. Transparency and sunshine is core to what OIGs do. And here at HHS OIG, our work plan, with the exception of certain cyber jobs is public. So when we decide to go forward with a job, we update our work plan and it’s a living work plan and we update it regularly and we would reach out to you to let you know, because we know you’re interested.

Super, thank you so much. I have a final question here about, I’ve seen that you have been alerting the public about fraud schemes related to COVID-19 on your website. You mentioned that scammers are offering COVID-19 tests to Medicare beneficiaries, mostly seniors, in exchange for their personal details, including Medicare information. And on your website, you go through a number of steps that seniors can take to protect themselves. But what proactive steps beyond having that information on your website. People are going to find that, I fear after they’ve been scammed and they’re looking for what to do. What proactive steps are you, the Office of Inspector General, taking to protect our seniors?

We are in constant contact with the CMS Center for Program Integrity. We work closely-

Great. Could you tell me what they are doing? Because I’d like to hear what Administrator Verma and CMS are doing about this.

Well, the first thing that any campaign related to protecting beneficiaries, it’s a phrase that’s been used for decades it’s, “Guard your card,” which is essentially, never share your beneficiary number. And now there are new numbers that are not linked to social security numbers. Do not share that with anyone that isn’t your doctor or providing care to you.

So some of the phishing schemes where folks are reaching out, offering test kits, sanitizing kits in return, just simply for your beneficiary number, don’t do that, never do that. That is meant to do sort of ill, to steal your medical identity. And in some instances, we’ve also sort of seen it associated with some kickback schemes, but guard your card, guard your number.

Okay. Thank you. I hope you’ll consider doing an investigation or job. Excuse me. Thank you for teaching me. I hope you’ll consider doing a job about how COVID related Medicare fraud has perhaps increased during this period and what additional steps we could ask CMS to be taking. Thank you so much. And I yield back.

If I could say one thing just to that, whenever we become aware of a fraud scheme, whether it’s a testing scheme or purported cure scheme, an identity theft scheme, we’re working very closely with the Department of Justice and our law enforcement partners. And when we can, we put out fraud alerts and we will continue to do that.

Speaker 3: (02:11:17)
Thank you so much. Thank you, I will now turn it over to the Chair for closing remarks. Chairwoman Maloney, you are now unmuted.

Carolyn Maloney: (02:11:27)
Oh, well, first of all, I want to thank all of my colleagues and thank you again to Mrs. Grimm for being here today. As we close, I’d like to reflect on why this briefing is so important. The coronavirus pandemic is a generational crisis and we are all in this together. If we face a second wave in the fall, as the director of the CDC and other public health experts have warned, we need to make sure that we are ready. And we need to replenish the national stockpile, we need to make sure hospitals are prepared for another surge if it happens. And as we find our way through this crisis, we will continue to depend on the HHS IG and all IGs to make sure our government’s response is effective, efficient, and accountable. Thank you everyone. [silence 02:12:16]

HHS Inspector General Christi Grimm Testimony Transcript on Trump Administration COVID-19 Response

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