[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]


                   INSIGHTS FROM THE HHS INSPECTOR GENERAL 
                     ON OVERSIGHT OF UNACCOMPANIED MINORS, 
                     GRANT MANAGEMENT, AND CMS

=======================================================================

                                HEARING

                               BEFORE THE

                        SUBCOMMITTEE ON OVERSIGHT AND 
                               INVESTIGATIONS

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             APRIL 18, 2023

                               __________

                           Serial No. 118-22
                           
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                           


     Published for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                              __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
54-888 PDF                  WASHINGTON : 2024                    
          
-----------------------------------------------------------------------------------                          
                        
                    COMMITTEE ON ENERGY AND COMMERCE

                   CATHY McMORRIS RODGERS, Washington
                                  Chair
MICHAEL C. BURGESS, Texas            FRANK PALLONE, Jr., New Jersey
ROBERT E. LATTA, Ohio                  Ranking Member
BRETT GUTHRIE, Kentucky              ANNA G. ESHOO, California
H. MORGAN GRIFFITH, Virginia         DIANA DeGETTE, Colorado
GUS M. BILIRAKIS, Florida            JAN SCHAKOWSKY, Illinois
BILL JOHNSON, Ohio                   DORIS O. MATSUI, California
LARRY BUCSHON, Indiana               KATHY CASTOR, Florida
RICHARD HUDSON, North Carolina       JOHN P. SARBANES, Maryland
TIM WALBERG, Michigan                PAUL TONKO, New York
EARL L. ``BUDDY'' CARTER, Georgia    YVETTE D. CLARKE, New York
JEFF DUNCAN, South Carolina          TONY CARDENAS, California
GARY J. PALMER, Alabama              RAUL RUIZ, California
NEAL P. DUNN, Florida                SCOTT H. PETERS, California
JOHN R. CURTIS, Utah                 DEBBIE DINGELL, Michigan
DEBBBIE LESKO, Arizona               MARC A. VEASEY, Texas
GREG PENCE, Indiana                  ANN M. KUSTER, New Hampshire
DAN CRENSHAW, Texas                  ROBIN L. KELLY, Illinois
JOHN JOYCE, Pennsylvania             NANETTE DIAZ BARRAGAN, California
KELLY ARMSTRONG, North Dakota, Vice  LISA BLUNT ROCHESTER, Delaware
    Chair                            DARREN SOTO, Florida
RANDY K. WEBER, Sr., Texas           ANGIE CRAIG, Minnesota
RICK W. ALLEN, Georgia               KIM SCHRIER, Washington
TROY BALDERSON, Ohio                 LORI TRAHAN, Massachusetts
RUSS FULCHER, Idaho                  LIZZIE FLETCHER, Texas
AUGUST PFLUGER, Texas
DIANA HARSHBARGER, Tennessee
MARIANNETTE MILLER-MEEKS, Iowa
KAT CAMMACK, Florida
JAY OBERNOLTE, California
                                 ------                                

                           Professional Staff

                      NATE HODSON, Staff Director
                   SARAH BURKE, Deputy Staff Director
               TIFFANY GUARASCIO, Minority Staff Director
              Subcommittee on Oversight and Investigations

                      H. MORGAN GRIFFITH, Virginia
                                 Chairman
MICHAEL C. BURGESS, Texas            KATHY CASTOR, Florida
BRETT GUTHRIE, Kentucky                Ranking Member
JEFF DUNCAN, South Carolina          DIANA DeGETTE, Colorado
GARY J. PALMER, Alabama              JAN SCHAKOWSKY, Illinois
DEBBIE LESKO, Arizona, Vice Chair    PAUL TONKO, New York
DAN CRENSHAW, Texas                  RAUL RUIZ, California
KELLY ARMSTRONG, North Dakota        SCOTT H. PETERS, California
KAT CAMMACK, Florida                 FRANK PALLONE, Jr., New Jersey (ex 
CATHY McMORRIS RODGERS, Washington       officio)
    (ex officio)
                             
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. H. Morgan Griffith, a Representative in Congress from the 
  Commonwealth of Virginia, opening statement....................     1
    Prepared statement...........................................     4
Hon. Kathy Castor, a Representative in Congress from the State of 
  Florida, opening statement.....................................    10
    Prepared statement...........................................    12
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................    14
    Prepared statement...........................................    16
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................    20
    Prepared statement...........................................    22

                               Witnesses

Christi A. Grimm, Inspector General, Department of Health and 
  Human Services.................................................    24
    Prepared statement...........................................    27

                           Submitted Material

Inclusion of the following was approved by unanimous consent.
List of documents submitted for the record.......................    65
Statement by Protect the Public's Trust, ``CDC & NIH to the 
  American People: You Can't Handle the Truth!,'' March 31, 2022.    66
Article of April 17, 2023, ``As Migrant Children Were Put to 
  Work, U.S. Ignored Warnings,'' by Hannah Dreier, New York Times    68

 
 INSIGHTS FROM THE HHS INSPECTOR GENERAL ON OVERSIGHT OF UNACCOMPANIED 
                   MINORS, GRANT MANAGEMENT, AND CMS

                              ----------                              


                        TUESDAY, APRIL 18, 2023

                  House of Representatives,
      Subcommittee on Oversight and Investigations,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 10:30 a.m., in 
room 2322, Rayburn House Office Building, Hon. Morgan Griffith 
(chairman of the subcommittee) presiding.
    Members present: Representatives Griffith, Burgess, 
Guthrie, Duncan, Palmer, Lesko, Crenshaw, Cammack, Rodgers (ex 
officio), Castor (subcommittee ranking member), DeGette, Tonko, 
Ruiz, Peters, and Pallone (ex officio).
    Staff present: Sean Brebbia, Chief Counsel; Deep 
Buddharaju, Senior Counsel; Sarah Burke, Deputy Staff Director; 
Lauren Eriksen, Clerk; Tara Hupman, Chief Counsel; Sean Kelly, 
Press Secretary; Peter Kielty, General Counsel; Emily King, 
Member Services Director; Chris Krepich, Press Secretary; John 
Strom, Counsel; Michael Taggart, Policy Director; Joanne 
Thomas, Counsel; Austin Flack, Minority Junior Professional 
Staff Member; Waverly Gordon, Minority Deputy Staff Director 
and General Counsel; Tiffany Guarascio, Minority Staff 
Director; Liz Johns, Minority GAO Detailee; Will McAuliffe, 
Minority Chief Counsel, Oversight and Investigations; Christina 
Parisi, Minority Professional Staff Member; Harry Samuels, 
Minority Oversight Counsel; Andrew Souvall, Minority Director 
of Communications, Outreach and Member Services; Caroline Wood, 
Minority Research Analyst; and C.J. Young, Minority Deputy 
Communications Director.

OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE 
         IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA

    Mr. Griffith. Welcome. Today's hearing is long overdue. It 
is my understanding that this is the first time in over 20 
years that the HHS Inspector General has appeared before the 
Energy and Commerce Oversight and Investigations Subcommittee.
    This morning's subcommittee hearing is our second 
Inspectors General hearing. As Oversight and Investigations 
Subcommittee chair, it is my intent to have Inspectors General 
testifying before us on a regular basis.
    Today, we will hear from Inspector General Christi Grimm on 
her office's ongoing oversight work and investigation 
priorities. We will focus on three critical areas that are 
plagued with issues and concerns that we must address moving 
forward.
    First, we will be examining HHS'ss abject failure to 
competently manage the record number of unaccompanied minors in 
the care of the Office of Refugee Resettlement, abbreviated 
ORR. The HHS Inspector General's office has done excellent work 
to shed light on this crisis.
    Back in February, we held a hearing on the border in Texas, 
and as I said at the time, the Biden administration's policies 
are the root cause of the border crisis we are experiencing. 
This only adds to the inhumane conditions experienced by 
unaccompanied children once they enter ORR care.
    The surge of unaccompanied children was an entirely 
foreseeable event of President Biden's refusal to secure the 
border. While running for office, President Biden pledged to 
reduce deportations and end Title 42. This encouraged more 
migrants, and the number of annual unaccompanied minors 
crossing the border during the Biden administration grew to 
astronomical numbers.
    From fiscal years 2018 through 2020, ORR averaged around 
44,500 referrals per year. In fiscal year 2022, ORR received 
over 128,900 referrals, almost three times the recent 
historical average.
    According to a report by CBS News, nearly 130,000 migrant 
children entered the U.S. Government's shelter system in fiscal 
year 2022. These numbers are staggering and a direct result of 
the Biden administration's open border policies.
    As the Inspector General has now documented across multiple 
reports, somehow HHS was caught unprepared for this surge, 
despite it being the natural result of administration policies.
    In a desperate attempt to increase capacity, ORR contracted 
with organizations with no relevant experience in safely caring 
for unaccompanied children. The result was child neglect and 
abuse.
    In an effort to quickly reduce the number of children in 
its care, ORR prioritized fast tracking the release of 
unaccompanied children to sponsors instead of taking the time 
and effort to thoroughly vet sponsors.
    The result was putting children at increased risk of being 
trafficked and exploited. We have all seen the news articles 
about children working full-time in slaughterhouses or as 
roofers or other dangerous and inappropriate professions.
    In response to this crisis, HHS continues to keep the 
assembly line of unaccompanied children moving as fast as 
possible.
    When whistleblowers raise concerns about children having 
panic attacks, self-harming, or living in unsuitable 
conditions, they are retaliated against.
    Further, HHS denied media access to emergency intake 
shelters.
    The priority seems to be to keep this issue out of sight 
rather than child welfare. It is unconscionable, and I want to 
thank the OIG's office for their work holding HHS accountable.
    The second area of focus for our hearing is NIH grant 
management. There is an increasing body of evidence suggesting 
that NIH fails to conduct routine oversight of grantees.
    This failure extends to research done in foreign countries 
involving potential pandemic pathogens, those such as the now 
infamous grant to EcoHealth Alliance. The Inspector General's 
audit found that NIH and EcoHealth Alliance failed to 
effectively monitor and document the activities of subgrantees, 
including the Wuhan Institute of Virology.
    As a result of NIH's failure to secure laboratory notebooks 
and other records, the U.S. Government has no adequate 
documentation of the coronavirus experiments conducted in Wuhan 
during the fall 2019. This is important because this is when 
COVID arose.
    In light of these oversight failures, it is 
incomprehensible to me that the NIH continues to fund EcoHealth 
Alliance when they failed to secure the documents required by 
their contracts that would have given us a better picture of 
COVID's origins.
    The final goal is to hear from the Inspector General about 
their work on Medicaid and Medicare program integrity.
    With the Public Health Emergency now officially over, 
returning Medicaid to its congressionally intended role as a 
safety net insurer of last resort is critical.
    Between fiscal year 2018 and fiscal year 2021, improper 
payments grew by over 138 percent.
    From reviewing the Inspector General's body of work on CMS 
oversight, it is clear that her office takes Medicare and 
Medicaid program integrity seriously. What is less clear to me 
is whether HHS and CMS are also committed to preventing fraud, 
waste, and abuse in these programs, or perhaps it is like the 
situation with the children: They would rather keep it out of 
sight and hopefully out of the minds of Congress.
    Thank you for your work, Ms. Grimm, but I can assure HHS 
that this is on the front of the minds of us in Congress who 
have oversight over them.
    Thank you, and I yield back.
    [The prepared statement of Mr. Griffith follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Griffith. I now recognize the ranking member, Ms. 
Castor, for her 5 minutes for an opening statement.

  OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF FLORIDA

    Ms. Castor. Well, good morning, and thank you, Mr. 
Chairman, and thank you especially for following through on 
your commitment after our discussion about keeping eyes on the 
unaccompanied children situation especially.
    And thank you, Inspector General Grimm, for being here 
today.
    HHS is a vital agency with enormous responsibilities that 
touches the lives of every American, and the agency ensures the 
health, safety, and well-being of people across the country.
    We recently had the opportunity to hear from Inspectors 
General from EPA, Department of Energy, Department of Commerce 
about how they are overseeing the deployment of funds from the 
bipartisan infrastructure law, the Inflation Reduction Act, 
CHIPS and Science Act, all historic legislation that is 
lowering cost, creating good jobs, and creating healthier, more 
resilient communities.
    I am very proud of our committee's leadership in enacting 
these landmark laws, but to ensure that they reach their full 
potential, we must remain committed to oversight.
    That is why the Inspector General is so important. There 
are areas of shared concern regarding HHS. In particular, 
Members on both sides of the aisle are alarmed over recent 
reports of child labor exploitation involving children who 
migrated to the U.S. without their parents and were placed with 
sponsors through the Office of Refugee Resettlement, ORR.
    While the administration has announced an interagency 
effort to crack down on exploitative child labor and provide 
responsive post-relief services to more children and improve 
sponsor vetting, additional reporting as recently as yesterday 
raises significant concerns.
    So it is important to hear from you, Ms. Grimm, about your 
ongoing oversight of HHS ORR. We know that long stays in 
Federal facilities are detrimental to the health and well-being 
of children.
    But HHS must ensure that it balances the need for efficient 
placement with the safety and high-quality services for 
children under ORR's care.
    On a different topic, I appreciate the lessons that have 
been learned, thanks to the IG's work with NIH throughout the 
pandemic. Federally funded research has led to breakthroughs 
that help us fight deadly diseases, make advancements in 
treatments and therapeutics, and develop lifesaving vaccines.
    NIH funding is a critical investment in our Nation's well-
being, and I am glad that the IG and NIH are working together 
to improve the agency's grant oversight.
    Oversight of NIH research funding is important, and it is 
our job to make sure that these dollars are well spent and well 
monitored.
    I hope we can move away from the politicization of the 
global pandemic that killed more than 1.1 million Americans to 
oversight and sensible policy reforms. We need to make sure 
that our oversight efforts are focused on improving NIH and the 
success of its grant-making work rather than limiting the 
ability to do important work, including with global partners.
    And I am confident that we can do that without vilifying 
individual scientists or tearing down our health institutions.
    We are also now less than a month away from another 
milestone for our Nation and for HHS. Thanks to the leadership 
of President Biden and congressional Democrats, we are on track 
to end the public health emergency.
    We must ensure that our neighbors who will see a change in 
their health coverage under the Medicaid unwinding are not lost 
in the shuffle.
    Democrats are taking responsibility for prioritizing 
efforts that make the Nation's health infrastructure stronger, 
protect and strengthen access to healthcare for everyone, and 
invest in future pandemic preparedness, while utilizing lessons 
learned over the past 3 years.
    I sincerely thank your office for the important work that 
you do to ensure integrity at HHS and prevent waste, fraud, and 
abuse of taxpayer dollars.
    Thank you, and I yield back.
    [The prepared statement of Ms. Castor follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Griffith. The gentlelady yields back.
    I now recognize the chairman--or chairwoman of the full 
committee, Mrs. McMorris Rodgers, for her 5 minutes for an 
opening statement.
    Madam Chair.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Mr. Chairman.
    And welcome to Health and Human Services Inspector General 
Christi Grimm.
    This is the first time in more than 20 years that the HHS 
Inspector General has appeared before the Oversight and 
Investigations Subcommittee. It is long overdue, and I am 
grateful that you are here.
    First, your office has done important work exposing how the 
administration has failed to assure the safety and well-being 
of unaccompanied children crossing the border. This is a 
crisis, and as the ranking member just said, it is alarming to 
all of us.
    And it has been made worse by President Biden's open border 
agenda. From 2019 to 2021, the number of unaccompanied minors 
referred to HHS from the Department of Homeland Security 
increased by more than 75 percent.
    Last year nearly 130,000 migrant children entered the 
shelter system, an all-time high.
    It is more than just numbers. The New York Times' 
investigation has revealed that unaccompanied migrant children 
are alone and being exploited. These are young teenagers 
without their parents, working long shifts on farms, in 
factories, hotels, and on construction sites.
    According to this Times investigation, HHS case workers are 
under pressure by the Biden administration to quickly process 
these children.
    As a result, sponsors are not being vetted properly, and 
Health and Human Services is not keeping track of these 
children. Quote, ``overall, the agency lost immediate contact 
with a third of migrant children.''
    That is tens of thousands of kids who are at risk of 
further exploitation, and we now know that children--people, 
were raising the alarm at HHS, including directly to Secretary 
Becerra.
    HHS and the Biden White House must be held accountable for 
how it could have possibly missed or ignored this crisis.
    In addition, we will also focus today on how HHS is 
spending and managing trillions of taxpayer dollars. This 
includes how the National Institutes of Health is failing to 
ensure proper oversight of its grants, especially in foreign 
countries like in China.
    We find the HHS OIG audit report about NIH's ineffective 
monitoring of the Wuhan Lab and EcoHealth Alliance very 
troubling, especially given the risky nature of this research 
and its potential to start a pandemic.
    It is unacceptable that today, because NIH failed to 
effectively monitor the Wuhan Lab and EcoHealth Alliance, that 
key data related to American taxpayer-funded grants is still 
under the control of the Chinese Communist Party.
    The American people deserve answers to this and also 
transparency if this failure to oversee grant funding is 
pervasive across HHS.
    Finally, we are also asking you to help us provide needed 
oversight of the Centers for Medicare and Medicaid Services, or 
CMS.
    CMS has an annual budgets of more than a trillion dollars 
and oversees or administers health coverage for millions of 
Americans.
    According to a CNBC report, there is more than $100 billion 
in fraud each year in Medicare and Medicaid. One criminal raked 
in millions from Medicare fraud, more than a decade, and he 
told CNBC, quote, ``I was low profile. Nobody knew me. I had 
everything. I had houses. I had cars. I had watches,'' end of 
quote.
    In addition, your written testimony discusses that, in 
fiscal year 2021 alone, improper payments made up for 21 
percent of all Medicaid spending. That is one in every five 
dollars spent improperly.
    These numbers are staggering. Surely, we can all agree that 
we need to ensure the integrity of the Federal health programs 
that so many people, including seniors, people with 
disabilities, mothers, and those most in need, rely on.
    With the end of the public health emergency, it is critical 
that CMS work to reduce the amount of improper payments by 
Medicaid and Medicare, and I hope to hear how the Inspector 
General's Office will help CMS restore the financial integrity 
of these programs as we return to normal postpandemic life.
    I worry not enough is being done by CMS and that the 
administration is reluctant to take commonsense actions that 
would reduce the instances of waste, fraud, and abuse. We want 
to hear more about the recommendations that you have for these 
vital programs.
    As I said in our hearing with the Inspectors General with 
other Federal agencies, responsible stewardship of Federal 
funds should not be a partisan issue. As duly elected Members 
of the People's House, it is our Article 1 responsibility to 
conduct oversight so the Government is responsible to those we 
serve.
    That is our goal today, especially for how the 
administration has made the border and cost-of-living crises 
worse.
    Again, Inspector Grimm, we are really pleased that you are 
here and look forward to your testimony regarding some of these 
most serious challenges.
    I yield back.
    [The prepared statement of Mrs. Rodgers follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Griffith. The gentlelady yields back.
    I now recognize the ranking member of the full committee, 
Mr. Pallone, for his 5 minutes.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Mr. Chairman.
    Today the subcommittee has a real opportunity to conduct 
important oversight of the Department of Health and Human 
Services, and I just hope we take advantage of this opportunity 
to put people over politics.
    After all, HHS's work is crucial to the everyday lives of 
Americans. It is tasked with ensuring the health of our 
families, the safety and development of new drugs, the response 
to public health emergencies and pandemics, and much, much 
more.
    And we are joined today by HHS Inspector General Grimm, 
whose office has the tremendous responsibility of overseeing 
the agency's critical work, and it is this committee's 
responsibility to ensure that HHS has the support it needs to 
carry out its work.
    Over the last couple of years, congressional Democrats have 
worked to provide HHS with the funding and authorities that it 
needed to address the pandemic and to make healthcare more 
affordable and accessible for American families. The American 
Rescue Plan provided HHS the tools and resources necessary to 
combat the pandemic by ramping up the distribution and 
administration of lifesaving vaccines.
    The American Rescue Plan and the Inflation Reduction Act 
expanded healthcare coverage and lowered cost through the 
Affordable Care Act marketplaces, saving the average family 
$2,400 a year in premiums.
    The Inflation Reduction Act is also lowering prescription 
drug prices for America's seniors, and these laws are making a 
real difference in the lives of the American people, and while 
we are still losing far too many Americans every day to COVID-
19, we have come a very long way thanks in large part to the 
hard-working public servants at HHS.
    Now, the key point of conducting congressional oversight is 
to examine how best we can improve and support Government 
agencies to ensure they work effectively for the American 
people. This is particularly important as the public health 
emergency ends. Emergency programs and authorizations will wind 
down and return to prepandemic operations. It is critical that 
during this transition, this committee, the IG, and the staff 
at HHS focus on how to support States and localities, as well 
as families emerging from the public health crisis.
    And while we are talking about HHS oversight, I must take 
this opportunity to say that HHS and, in particular, the Food 
and Drug Administration, face serious threats from extremist 
Republican-appointed judges.
    In a case challenging FDA's decades-old approval of the 
drug mifepristone, these extreme judges are making 
unprecedented decisions that are not grounded in science or in 
law. The case is now sitting before the Supreme Court, and on 
Friday, 253 Members of Congress filed an amicus brief seeking 
to protect the FDA against this unwarranted judicial intrusion.
    Two decades of science and FDA analysis have clearly 
demonstrated that this drug is safe, and it is imperative that 
women have access to medication abortion as some States 
implement increasingly draconian restrictions on women's 
reproductive healthcare.
    But this lawsuit by right-wing extremists seeks to 
completely undermine FDA's authority to approve drugs and to 
damage FDA's hard-earned reputation as the international gold 
standard in drug approval.
    Our agencies need to be the ones making the important 
decisions based on data and science, not partisan judges, and 
doctors must be able to prescribe safe, approved drugs to their 
patients without the interference of lawyers.
    These decisions attempt to undermine FDA's drug approval 
process and restrict access to FDA-approved medication. That is 
why all 23 committee Democrats have committed or have requested 
an immediate hearing in this committee on the unprecedented 
decisions threatening our healthcare institutions.
    Scientists are against this radical judicial intervention. 
The pharmaceutical industry is against it. Doctors are against 
it. And patients are against it.
    So while I appreciate today's hearing with Inspector 
General Grimm, the Republican Majority should immediately 
schedule a hearing on this existential threat to FDA's drug 
approval authority. We simply must examine the impacts of these 
extreme decisions that place ideology, politics, and judicial 
activism above science.
    And with that, I yield back, Mr. Chairman.
    [The prepared statement of Mr. Pallone follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Griffith. The gentleman yields back.
    And it now concludes Members' opening statements. The Chair 
would like to remind Members that, pursuant to committee rules, 
all Members' written opening statements will be made a part of 
the record. Please provide those to the Clerk promptly.
    All right. Now, we have the opportunity to introduce our 
witness today. We want to thank our witness for being here 
today and taking the time to testify before the subcommittee.
    You will have the opportunity to give an opening statement 
followed by a round of questions from Members.
    Today's witness is the Honorable Christi Grimm, Inspector 
General for the Department of Health and Human Services.
    We appreciate you being here today and look forward to 
hearing from you. As you are aware, this committee is holding 
an oversight hearing, and when doing so, it has been the 
practice of this committee to take testimony under oath.
    Do you have any objections to testifying under oath?
    Ms. Grimm. I do not.
    Mr. Griffith. She does not.
    Seeing no objection, we will proceed.
    The Chair also would advise you that you are entitled to be 
advised by counsel, pursuant to House rules. Do you desire to 
be advised by counsel during your testimony today?
    Ms. Grimm. I do not.
    Mr. Griffith. And seeing no request for counsel, please 
rise and raise your right hand.
    [Witness sworn.]
    Mr. Griffith. Seeing the witness answered in the 
affirmative, you are now sworn in and under oath, subject to 
the penalties set forth in Title 18, Section 1001 of the United 
States Code.
    With that, I now recognize Inspector General Christi Grimm 
for her 5 minutes to give an opening statement.
    Ms. Grimm.

STATEMENT OF CHRISTI A. GRIMM, INSPECTOR GENERAL, DEPARTMENT OF 
                   HEALTH AND HUMAN SERVICES

    Ms. Grimm. Good morning, Chairman Griffith, Ranking Member 
Castor, Chair McMorris Rodgers, and Ranking Member Pallone, 
also distinguished members of the subcommittee.
    I am Christi Grimm. I am the Inspector General for the U.S. 
Department of Health and Human Services.
    Our mission at HHS OIG is to prevent, detect, and combat 
fraud, waste, and abuse. Our work helps ensure that HHS 
programs better serve the American people and that taxpayer 
dollars are not misspent.
    Our portfolio is vast, and it is varied. Last year my 
office was responsible for oversight of over 100 programs and 
more than $2.4 trillion in Department expenditures. We have 
only 2 cents for every $100 that the Department spends.
    We conduct efficient, consequential, high-impact oversight 
work with our limited resources, but much more needs to be done 
to thwart fraud, identify misspent funds, and protect people 
from harm.
    To be candid, without more resources we will be unable to 
keep pace with the Department threats. We risk falling behind 
and allowing HHS dollars to be diverted to fraud.
    I will spend the next few moments briefly addressing the 
three specific areas the subcommittee requested.
    First, the unaccompanied children program. Ensuring that 
children are safe is a top priority for me and my office. 
Unfortunately, our oversight work over the past two decades has 
raised a variety of concerns about the safety and welfare of 
unaccompanied children in HHS'ss care.
    Unaccompanied children enter the U.S. with no parent or 
guardian to care for them. HHS is completely responsible for 
their well-being until being released to an adult sponsor in 
the U.S.
    A recent report focusing on case management services at the 
Fort Bliss Emergency Intake Site demonstrates the child safety 
risks our work has uncovered. At this site we found many 
caseworkers lacked experience and did not receive adequate 
training.
    We identified that the case management system was lacking 
in basic capabilities, including helping to screen the adults 
the children were to be placed with. We found the streamlined 
process to expedite children's release from the facility may 
have increased risk of release to unsafe adult sponsors.
    Finally, we heard from staff that they were reticent to 
report problems for fear of retaliation. We are now conducting 
a more comprehensive review of the process used to screen 
potential adult sponsors.
    Next, I will turn to grants management at NIH. We have 
found consistent weaknesses in NIH's oversight of grant 
recipients. These include fraud, unallowable costs, and 
inadequate internal controls and monitoring of grants.
    For instance, a recent audit found the NIH and its grant 
recipient EcoHealth Alliance did not effectively monitor awards 
and subawards.
    The report also found that NIH did not exercise rigorous 
oversight over potentially high-risk research.
    While issues related to the type of research and science 
may be complex, our findings involve common failures of routine 
grant oversight, like failing to follow up on progress reports.
    Last, I will touch on oversight of FEMA. The intricacy and 
breadth of the Medicare and Medicaid programs make oversight 
complex, challenging, and resource intensive for CMS. We use a 
data-driven risk assessment approach to target risks, such as 
inflated costs, improper or wasteful payments, and poor quality 
of care.
    We also deploy sophisticated data analytics and technology 
to pinpoint and pursue costly and harmful fraud schemes.
    Yet despite extensive reviews and enforcement, our limited 
resources do not allow us to provide comprehensive oversight of 
Medicare and Medicaid, programs that spend $1.6 trillion 
annually. Said simply, we lack a sufficient number of law 
enforcement agents, auditors, evaluators, and information 
technology specialists to detect and respond to ever-emerging 
fraud trends.
    OIG is turning down between 300 and 400 viable criminal and 
civil healthcare fraud cases annually. These uninvestigated 
cases represent unchecked fraud and the potential for patients 
to be put in harm's way.
    Notwithstanding rigorous efforts by my office, by HHS, and 
Congress, serious fraud, waste, and abuse continue to grow and 
threaten HHS programs. If enacted, the President's fiscal year 
2024 requested resources for OIG would go a long way toward 
addressing shortfalls, particularly with respect to combating 
fraud.
    I thank you for the invitation to appear before you today. 
I thank you for underscoring the importance of resources for 
program integrity. I thank you for your commitment to improving 
HHS programs and protecting the people they serve. And I am 
happy to take your questions.
    [The prepared statement of Ms. Grimm follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Griffith. Thank you. Thank you for your testimony.
    We will now move to the question-and-answer portion. I will 
begin the questioning and recognize myself for 5 minutes.
    I said this in a hearing recently or in comments: The 
opposite sides of the aisle may not agree on the policies that 
brought these children to our border, but once they are in our 
care and we have taken responsibility for them, I think we all 
agree that they ought to be taken care of properly.
    They ought to be getting educated. They ought not be just 
disbursed as the labor for construction or plants where they 
are putting together packages of cups or vegetables, whatever 
it might be.
    As a background note, at one time in my life I practiced in 
domestic relations and did child custody cases, was a guardian 
ad litem for children, and I went to Fort Bliss in 2021, and I 
started asking questions. And the answers I got were shocking. 
So I have been raising this issue since that time, but it does 
not seem like it has been doing any good.
    You have done a report now and you have indicated that 
there are some preliminary things that are happening. What is 
HHS doing to make the vetting process of these sponsors better?
    Because when I was there, they basically were just checking 
on the Internet to see if they had any violent crimes or crimes 
against children on their record. They were not looking into 
what kind of house they were going to be in, what the sleeping 
arrangements were, what school they were going to, all things 
which as a guardian ad litem or somebody who was practicing in 
domestic relations would have checked into for the safety of 
the child before I ever advised the court that I thought the 
child should be placed in one home or another home or wherever.
    So what are they doing differently now that they were not 
doing in 2021?
    Because based on the press reports and your report, it does 
not look like much has changed.
    Ms. Grimm. Thank you, Chairman Griffith, for your question.
    We did do a report looking at Fort Bliss. We did an 
inspection of that site. We interviewed 66 ORR officials. We 
made nine recommendations in that report. We are in receipt of 
the Department's response to that report.
    If I may----
    Mr. Griffith. Yes, ma'am.
    Ms. Grimm [continuing]. I will highlight three key areas 
that are of utmost importance that the Department, that ORR get 
right.
    The three themes, and these capture findings across many of 
our reports, including Fort Bliss, include hiring, screening, 
and retaining qualified facility employees.
    The second has to do with A robust, fully functioning 
electronic case management system.
    The third is communication internally and externally that 
prioritizes children's interest and concerns about potential 
harm to children.
    We are in response of their response from our Fort Bliss 
report. They are undertaking action. We consider the 
recommendations still open until we can examine the 
documentation.
    If you were to ask me what the number one thing they need 
to be working on and to do to get right, it is to completely 
overhaul the ORR portal before the next anticipated surge. It 
has not been functional for an incredibly long time, and there 
have been starts and stops, and they have begun again, but they 
need to get it right.
    Mr. Griffith. And when you say ``portals,'' for the folks 
watching back home, that is the process they use to take 
children who have come to the border unaccompanied and give 
them to some kind of a sponsor.
    I would hope that they would do a better background vetting 
because, according to the latest report from the New York 
Times, the administration is taking the position that, once 
they have released them, they no longer have any 
responsibility.
    So we had better be sure we are putting them into good 
homes before we release them, because there were too many 
reports of kids not being educated and working long hours 
overnight.
    You know, one child complained that he would really like to 
learn how to read but he cannot, and he has been with the 
sponsor now for a couple of years. It is outrageous.
    Are they moving in that direction?
    I know that it is not easy, but are they moving in that 
direction based on what you have seen, or is it too early to 
tell?
    Ms. Grimm. You raise a number of different dimensions----
    Mr. Griffith. I do.
    Ms. Grimm [continuing]. Of sponsor screening. I am going to 
zero in on our Fort Bliss report.
    We did find that the case managers, some of them were not 
qualified. They did not receive training. They struggled to do 
things like vet sponsors.
    We found that the case management system and UC Portal, 
that it frequently crashed. It did not allow for searches of 
things like addresses and prior sponsors that may have had 
children before.
    They waived certain requirements for sponsor vetting that 
included looking at adults that might be in the household for 
certain categories of sponsors.
    All of these things elevated risks.
    Mr. Griffith. Yes.
    Ms. Grimm. We had recommendations for all of this. They are 
reporting that they are working on it. We need to review 
documentation to be sure they are headed in----
    Mr. Griffith. And we will probably have another hearing 
later this year on this same subject just to follow up--at 
least one, maybe two more, because I think we are all very 
concerned about it.
    And I think we have got to do better because what we are 
doing is we are creating a subclass out of these unaccompanied 
children who can be exploited, and that is not appropriate. 
That is not what this was set up to do, and I do not think 
anybody on either side of the aisle is in favor of that.
    That being said, I have used up my time. I yield back and 
now recognize Ms. Castor, the ranking member, for her 5 minutes 
of questioning.
    Ms. Castor. Well, thank you, Mr. Chairman.
    And I would wholeheartedly agree that we need to have a 
followup oversight hearing on this topic.
    And thank you, Ms. Grimm, for your attention and 
recommendations to keeping unaccompanied children safe. These 
reports are alarming and disturbing, and we have got to help 
you, help the agency repair so children are kept safe.
    I have a basic question for you. When does the Office of 
Refugee Resettlement responsibility begin and where does it end 
when it comes to the well-being of the unaccompanied children?
    Ms. Grimm. Typically, when the Department of Homeland 
Security moves a child that is considered unaccompanied into 
the ORR Program, and they are asked to do that at DHS within 72 
hours, they then become where they are in the custody of HHS.
    Typically, they would go into a facility, be vetted for a 
sponsor. When they are placed with a sponsor, it is the 
Department's interpretation of existing legislation that, when 
they are transferred to a sponsor, legally their jurisdiction 
does end.
    However, we have recommended they have committed to do 
welfare checks, but it is their legal read that their custody 
ends when they are transferred to an adult sponsor here in the 
U.S.
    Ms. Castor. I see. Because there just seems to be an 
overarching responsibility to ensure that those children are, 
first and foremost, getting to school and are being kept safe.
    So you are saying that HHS, now they are instituting some 
of your recommendations for case management in those welfare 
checks, but is there something additional in the law where we 
need to spell out succinctly a requirement for those ongoing 
welfare checks?
    At that point, is it a State responsibility under the State 
child welfare laws?
    Ms. Grimm. So I know that Secretary Becerra recently 
testified on this and testified on the jurisdiction. We do not 
get in the middle of that interpretation of legal jurisdiction.
    I want to clarify something that I said. There are certain 
circumstances for certain children where the Department does 
work to connect them with certain social services, medical 
services. So there is a certain category of children. I do not 
know all of the specifics about that.
    Ms. Castor. OK. I understand that you are, in addition to 
your ongoing analysis here, you have an ongoing study----
    Ms. Grimm. Yes.
    Ms. Castor [continuing]. Underway. When can we expect your 
latest recommendations to be released?
    Ms. Grimm. Representative Castor, we have several ongoing 
studies. The study that I believe you are most interested in 
has to do with the vetting of sponsors.
    Ms. Castor. Yes.
    Ms. Grimm. We have completed data collection. We are 
developing the findings.
    I would expect that report to be in draft within the next 
couple of months.
    Ms. Castor. OK. And I heard you loud and clear: The most 
critical piece right now to ensure the appropriate vetting of 
sponsors is the overhaul of the ORR Portal. And does the 
agency--does HHS have adequate funding right now and 
contractors to make that happen?
    Ms. Grimm. The question on whether they have adequate 
funding, I do think that is a better question for ORR to 
respond to.
    As far as why it matters, it is the case management system 
ORR uses to oversee the well-being and safety of children while 
they are in care. It is the tool ORR uses to ensure adequate 
sponsor screening to ensure children are not placed with labor 
or sex trafficking situations.
    It is what they use to track separated children so they can 
be reunited with parents when appropriate. It is where they 
monitor incidents of potential physical or sexual abuse while 
in HHS custody.
    And all of our experience as an OIG teaches us that you 
need effective data systems to conduct meaningful oversight. 
They have responded to us that they have taken, I believe, 70 
specific actions for the UC Portal.
    I will be candid. We have been here before, and I think the 
proof will be in the eating of the pudding. We have to see 
whether those outputs translate into better functionality for 
the system, better functionality for case managers to vet 
sponsors.
    Ms. Castor. Thank you. And we are committed to that as 
well.
    Thank you very much. I yield back.
    Mr. Griffith. The gentlelady yields back.
    I now recognize the chair of the full committee, Mrs. 
McMorris Rodgers, for her 5 minutes of questioning.
    Mrs. Rodgers. Thank you, Mr. Chairman.
    Today's New York Times has an article: migrant children 
worked as U.S. ignored warnings, whistleblowers say White House 
officials were alerted about risk to minors.
    Without objection, I would like to have this article 
inserted into the record.
    Mr. Griffith. Madam Chair, is that the article where Matt 
Haygood, Senior Director of Children Services of the U.S. 
Committee for Refugees and Immigrants, asked the question, 
``We're waiting for the congressional hearing that's like, 'How 
did this happen to all these kids?'''?
    Mrs. Rodgers. Yes. Yes, Mr. Chairman.
    Mr. Griffith. All right. Without objection, tender into the 
record.
    [The information appears at the conclusion of the hearing.]
    Mrs. Rodgers. Thank you.
    It is a deeply disturbing investigative piece on child 
exploitation. It details how the administration ignored 
multiple whistleblowers who raised concerns about the loosening 
of restrictions on who HHS would release these unaccompanied 
minor children to.
    The whistleblowers saw that the children were being 
exploited and raised concerns to their superiors who, in turn, 
raised it up the chain all the way to the White House.
    However, the White House denies any knowledge, and I quote, 
``Andrew J. Bates, White House Deputy Press Secretary, said, 
'Officials there had not known of the increase in child labor 
until the Times' February report,''' end of quote.
    Mr. Grimm, your office conducted in-depth and rigorous 
investigations into the Trump White House's involvement in 
ORR's unaccompanied children program.
    Is the White House telling the truth about when it knew 
there was a rise in child exploitation as a result of ORR's 
decision to cut short sponsors' background checks?
    Ms. Grimm. Chairwoman Rodgers, I cannot speak to what the 
White House knew and when.
    Mrs. Rodgers. Ms. Grimm, will you commit to conducting a 
full investigation to determine when HHS notified the White 
House and how it did so?
    Ms. Grimm. As part of our review of potential risks with 
sponsor placements, we typically do review correspondence. I 
will tell you that some of that information would be protected 
by privilege.
    But we are reviewing sponsor placement, and we hope that 
that report can be illuminating, and I am familiar with the New 
York Times' report from yesterday.
    Mrs. Rodgers. I look forward to your work and that report.
    Medicaid has faced persistent challenges related to 
improper payments and enrollment concerns. As you know, 
ensuring integrity of this program requires effective 
eligibility verification processes and robust collaboration 
between your office and States.
    And I would like to focus on issues related to verifying 
eligibility for Medicaid. One issue that your office has 
frequently written about is the prevalence of States paying per 
member per month to Medicare managed care organizations for 
deceased beneficiaries.
    In simple terms, dead people are continuing to participate 
in Medicaid at taxpayer expense. I hope I am on safe, 
bipartisan footing when I say that we should not be paying for 
care of those who have already passed.
    And your office seems to agree that we have, as we have 
sought to recoup payments for these claims.
    Can you speak to what CMS and the States could be doing to 
mitigate these issues?
    Ms. Grimm. I can. I think in your opening statement, 
Chairwoman Rodgers, you had pointed to practical 
recommendations, practical things that CMS can be doing.
    Our portfolio of CMS oversight is vast and varied. We have 
recommendations that are cost savers. We have recommendations 
related to patient harm. We have recommendations related to 
improper payments.
    Is there a specific category you would like me to zero in 
on?
    Mrs. Rodgers. Yes. Well, I would like to ask, would it be 
appropriate to advise States to regularly check databases, like 
the Death Master File, DMF, to ensure States are not paying for 
deceased beneficiaries?
    Ms. Grimm. Yes.
    Mrs. Rodgers. OK. And will your office commit to reviewing 
current CMS practices and policies for interacting with States 
on eligibility determination systems, as well as identifying 
any areas for improvement and enhancement?
    Ms. Grimm. As part of the public health emergency 
unwinding, we are doing work where we are looking at Medicaid 
eligibility, where we are looking at errors, and I would need 
to look to see if that is already a part of that.
    But your requests sound very reasonable, Madam Chairwoman.
    Mrs. Rodgers. Thank you.
    The OIG audit of EcoHealth Alliance grant found NIH did not 
comply with the requirement to contact EcoHealth within 30 days 
of the nonprofit's failure to file its year five progress 
report.
    Who at NIH was specifically responsible for this followup?
    And what was the breakdown that led to NIH noncompliance?
    Ms. Grimm. So I want to be very clear about what our 
EcoHealth report did and did not do. The objectives of that 
report were to look at NIH's adherence of our requirements for 
grant oversight and for EcoHealth's adherence to Federal 
requirements.
    At the outset I want to be clear. We did not look at things 
like gain of function or the origins of COVID. I just want to 
be clear about that.
    Mrs. Rodgers. OK.
    Ms. Grimm. So who was responsible?
    Mrs. Rodgers. Yes.
    Ms. Grimm. NIH had responsibilities for monitoring 
EcoHealth. EcoHealth had responsibilities for monitoring the 
Wuhan Institute of Virology and other----
    Mrs. Rodgers. Well, who specifically at NIH is responsible 
for this followup?
    Ms. Grimm. I don't have at my fingertips the exact title of 
the person that would be responsible for followup on----
    Mrs. Rodgers. OK. I want to ask you to get back with the 
committee on that answer because we need to be looking for 
personal accountability and an understanding of what broke down 
so we can take the corrective action necessary.
    I yield back, Mr. Chairman.
    Mr. Griffith. I thank the gentlelady.
    I now recognize the ranking member of the full committee, 
Mr. Pallone, for his 5 minutes of questioning.
    Mr. Pallone. Thank you, Mr. Chairman.
    As you highlight in your testimony, the public health 
emergency due to COVID-19 will be ending next month, resulting 
in a great deal of change across the health landscape. You 
particularly noted that there are, quote, ``risks associated 
with the termination of waivers and flexibilities that were 
permitted under the public health emergency.''
    And I share your concern and want to make sure that HHS and 
its partners are responsibly making this transition without 
Americans in need of healthcare falling through the cracks.
    So the question is, could you speak a little more about 
what particular risk you see with the unwinding of the public 
health emergency and how your office is preparing to assess 
those risks?
    Ms. Grimm. So one of the key focuses, Representative, that 
we are looking at is Medicaid and Medicaid eligibility. We have 
reason to be concerned about this. As pointed out, last year 
the error rate for Medicaid was over 21 percent. We have a 
rolling three-year average of 15 percent in errors.
    Our historic work has found issues particularly as it 
relates to eligibility. So we are interested in taking a look 
in the PHE unwinding, the process for determining whether 
enrollees continue to be eligible or not, the accuracy that 
those who should have benefits do not lose them and those that 
should not have benefits are not enrolled.
    Mr. Pallone. All right. Thank you.
    Now, it is important that your office be adequately 
resourced to conduct oversight. As your testimony notes, 
President Biden's budget seeks an increase of $52.5 million for 
your office next year.
    So if your office were appropriated those additional 
resources, where would you focus on enhancing your oversight 
capabilities?
    Ms. Grimm. We would absolutely be starting with 
investigations. We, as I mentioned, are turning down between 
three and four hundred cases a year. The budget, if approved, 
implemented, would allow us to hire more agents to address some 
of that case backload.
    Mr. Pallone. OK. Now, you mentioned, of course, that 
rooting out healthcare fraud is essential to ensuring that 
appropriated dollars are spent where they are actually needed.
    And you state in your testimony that, due to a lack of 
resources, you, quote, ``turned down 684 CMS cases for 
investigation.''
    So can you describe the impact on the healthcare system 
when you are not adequately resourced to investigate fraud?
    Ms. Grimm. So those are significant cases that CMS refers 
over to us. We work closely with CMS, the Center for Program 
Integrity, and I will note that we have a very positive working 
relationship.
    So what that means is that there is unchecked fraud. We 
triage. I want to assure you that we are not letting, in our 
assessment, the highest risk of those that present the most 
harm or the most exposure to payment and people go unaddressed, 
but we are not able to get to certain very important cases 
because of lack of resources.
    Mr. Pallone. OK. Now, my last question. You also state in 
your testimony that your fraud investigations can, quote, 
``return stolen money to the American people.'' Do you have an 
estimate of how much money your fraud investigations have 
recovered in prior years?
    Ms. Grimm. I do, if I could just turn to----
    Mr. Pallone. Take your time.
    Ms. Grimm. So combined expected recoveries for our audits 
and our investigations last year were $4 billion. The return on 
investment for expected recoveries is 11 to 1, and that every 
$1 invested in us we return or we expect to return $11 to 
taxpayers to the Trust Fund.
    Mr. Pallone. Well, that is very impressive.
    So thank you, and thank you for the important work to 
uphold the financial integrity of the programs that I think are 
really central to long-term health and well-being of all 
Americans.
    Thank you, Mr. Chairman. I yield back.
    Mr. Griffith. The gentleman yields back.
    I now recognize Dr. Burgess of Texas for his 5 minutes of 
questioning.
    Mr. Burgess. I thank the chairman.
    And historically I do want to point out how this 
subcommittee really has affected a lot of the positive changes 
that have occurred at ORR, going back to 2014. The oversight of 
this subcommittee has been important. It is important that it 
be ongoing.
    Like Chairman Griffith, I am concerned because the ability 
to release a child to someone who has not been properly checked 
is of great concern.
    I adopted a child at one point, and the scrutiny that I was 
put under as an adoptive parent I will admit at times felt 
intrusive, but at the same time you realize you are placing a 
vulnerable individual with the care of a family.
    And then Chairwoman Rodgers already put it in the record, 
but this New York Times article dated yesterday is one of the 
most searing and unfortunate recitations that I have ever seen.
    So I guess it just begs the question. Well, you have got in 
your written testimony and you mentioned a report entitled 
``Operational Challenges within ORR and the ORR Emergency 
Intake at Fort Bliss.'' And I appreciate you including that 
reference.
    I pulled that, and it is apparent from that report that 
there were some changes in the guidance, the field guidance 
that occurred. Can you tell us a little bit about that, why 
that was necessary?
    Ms. Grimm. I thank you, Representative Burgess, Dr. 
Burgess, and I do remember coming up to talk to you at one 
point about unaccompanied children.
    The changes to the screening, there were reduced 
safeguards. They removed background checks and identity 
verification.
    So let me just back up. This was during the height of the 
surge in 2021 for the emergency intake facility at Fort Bliss. 
This guidance did apply more broadly though.
    They removed background checks and verification for other 
adult household members and alternative----
    Mr. Burgess. And let me just stop you there because that is 
my concern.
    Ms. Grimm. Yes.
    Mr. Burgess. I mean, who has the authority? Is it the 
agency?
    Are you required to follow law as passed by Congress, or 
can the Secretary or someone just decide, ``Hey, this is too 
much trouble, we want to do things differently''?
    I kind of knew this was happening, but like the chairman, I 
went to Fort Bliss in 2021. I went again in 2022, where we saw 
on the television the numbers were vastly increasing. Their 
length of stays was decreasing, and the number of occupants 
were decreasing. That told me you are sending kids out there 
and you do not know where they are going or who they are going 
to.
    Was I wrong about that?
    Ms. Grimm. Are you asking if the sponsor screening was not 
adequate?
    I want to make sure I understand the question.
    Mr. Burgess. Well, I think I know that it was not, but I 
guess the big question is who had the authority.
    Page 15 if your report, where ORR issued field guidance 
that removed certain steps of the sponsor screening process 
across ORR facilities, potentially increasing children's risk 
of release to unsafe sponsors.
    No kidding. It really did. So who makes that decision?
    Ms. Grimm. That would be HHS would have the ability to make 
the decision to issue guidance. This was field guidance issued 
by HHS, by ACF, by ORR.
    Mr. Burgess. But when you start to connect the dots and you 
read the New York Times article, it sounds like the domestic 
policy advisor, Susan Rice, in the White House was kind of 
putting some pressure to let's get the throughput.
    And Secretary Becerra himself was quoted in a previous New 
York Times article as saying, you know, if Henry Ford was 
running this, we would get these kids through a lot faster.
    But that is not the correct way to do things, and we all 
recognize that. That is why there are rules in place.
    I guess my question is, who thought that it was OK to 
change the rules without consulting the legislative branch?
    Ms. Grimm. I want to underscore the role of an Inspector 
General. We are independent. We are objective. We strive for 
transparency and accountability. We do not make the rules. We 
assess programs according to the rules that exist.
    In our Fort Bliss report, we do point out that those waived 
requirements in combination with a variety of other factors 
increased the risk that children could go to an unsafe sponsor. 
We recognize the need for efficient and expeditious transition 
to a sponsor, but it needs to be done safely.
    Mr. Burgess. Yes, it does need to be done safely. 
Ultimately the decision was made by the Executive. People do 
need to hold the White House accountable on this. It is 
shameful. It should never have occurred.
    Mr. Chairman, I have got a bunch of other questions. I will 
submit them for the record, but I do want to thank you for 
holding this hearing today, and I just support your statement 
that you are going to hold additional hearings here.
    Mr. Griffith. I thank the gentleman. He yields back.
    I now recognize the gentlelady from Colorado, Ms. DeGette.
    Ms. DeGette. Thank you so much, Mr. Chairman.
    And I agree with Mr. Burgess because this committee has had 
a long history of conducting bipartisan oversight of the Office 
of Refugee Resettlement because these kids are so vulnerable, 
and it is really important that we get this right.
    We had a long series of investigations. There was a hearing 
in 2021 that I chaired with the administration looking at the 
progress that the Biden administration made in reuniting the 
thousands of separated children that were actually not 
unaccompanied. They actually--well, I guess they were 
unaccompanied. They showed up.
    But they--no, they were with their families. They were 
ripped apart under the Trump administration policies, under the 
family separation policies, and so this hearing we had in 2021 
was about what was going on with reuniting those kids with 
their families.
    And I just want to, Inspector General Grimm, I want to ask 
you about the current issues, but I want to--I always ask for a 
status update of that because a lot of Members of Congress are 
shocked to learn there are still many children who were taken 
apart from their families who have never been reunited.
    So I am wondering if you know how many children who were 
separated under that program still have not been reunited with 
their families.
    Ms. Grimm. Thank you, Representative DeGette. I do not have 
the precise figure of reunited. I do want to point out that one 
of our reports in the early days identified children who had 
been separated from their parents were not categorized as being 
separated in the HHS system. Our report led to the 
identification of over 2,000 children who were then meant to be 
reunited with their parents.
    I can look into that figure and get back to you with that.
    Ms. DeGette. I would love that, and I do want to thank you 
because that was the OIG that helped that happen. But my 
understanding is there are still hundreds of kids who were not 
reunited with their parents.
    Many of the--and, of course, as time goes on, it gets more 
and more difficult. Their parents have returned to the home 
countries or whatever it is.
    So I would appreciate getting that information because I 
think it is important that we continue to keep eyes on that 
issue to make sure that it is still continuing to happen.
    And to that point, I wanted to--you know, one of the 
issues--and I think you have alluded to this, because OIG has 
produced 27 reports on ORR in the last 6 years highlighting the 
challenges and risks caring for, quote, ``fluctuating numbers 
of children entering ORR's care.''
    And that is part of the problem, which is you might have a 
huge surge in kids showing up unaccompanied, and then it might 
plummet down. So how you implement and administer consistent 
policies, I think, has been a challenge.
    So I want to ask you: How many of the recommendations that 
you all have made has ORR implemented fully or partially, and 
how many remain still open?
    Ms. Grimm. Thank you for your question, Representative 
DeGette.
    We have 57 open recommendations. I believe I do not have 
the count of recommendations that have been implemented. I do 
not want to give you wrong----
    Ms. DeGette. If you can supplement your--also with that, 
that would be really helpful.
    And do you--what progress would you say HHS has made in 
improving the ability to provide for the, quote, ``medical and 
mental health needs of children in ORR care'' that you 
mentioned in your testimony?
    Ms. Grimm. There have been strides that have been made in 
connecting children with appropriate mental health services 
both when they are within the custody of ORR and, I believe, in 
ensuring that they are connected with those services 
postrelief.
    Ms. DeGette. So would it be your assessment that part of 
the problem is a lack of resources that hinder ORR's ability to 
care for the minors in its custody, particularly during these 
surges?
    Ms. Grimm. I cannot comment on the adequacy of resources 
that ORR has. I do know that we have recommended that this 
program be treated like an emergency with ups and downs in 
transfers and census. But I cannot comment on the adequacy of 
the resources they have.
    I do believe that is a better question for the Department.
    Ms. DeGette. Why can't you comment on the adequacy of the 
resources?
    Ms. Grimm. I do not have those figures in front of me. I 
have not done any cost-benefit analysis.
    Ms. DeGette. So we would need to ask someone from the 
agency?
    Ms. Grimm. Yes.
    Ms. DeGette. OK. Thank you. We will.
    Thank you. I yield back.
    Mr. Griffith. The gentlelady yields back.
    I now recognize the gentleman from Kentucky, Mr. Guthrie, 
for his 5 minutes of questions.
    Mr. Guthrie. I thank the Chair for the recognition.
    And I thank the witness for being here with us today.
    And I want to associate myself with the thoughts that have 
been expressed by my previous two Members and actually with Dr. 
Burgess. We did go to the ORR facility, Fort Bliss, and it is 
bipartisan. We want everybody to be treated with respect.
    I will just point out the issue that seems to be happening 
to the children is, according to the Border Patrols, is what 
happened for the cartels is they come up through Northern 
Mexico, and that is not the purpose of this hearing, but we 
cannot talk about what happens to our children without 
mentioning the atrocious thing about the border policy.
    What is atrociously happening to them is our border policy 
is attracting migrants to the border, is happening to our 
children, and it is sad. It really is upsetting.
    But I know this is a subject for a hearing with different 
reports on different subjects. I am going to change the 
subject, but I do want to associate with that before I do so.
    On your June 2020 report for the FDA inspection process, 
and I will quote from the report. It says, ``According to FDA, 
the investigators' supervisors are responsible for ensuring 
that the investigators are qualified to conduct inspections. 
FDA did not have written policies or procedures that require 
the supervisor to verify that investigators that were assigned 
met the right training.''
    I will get to the question. Are there currently policies in 
place at FDA to ensure supervisors are aware and notify their 
lead investigators about these important training requirements?
    And why did they not exist prior to your investigation?
    Ms. Grimm. Thank you for your question, Representative 
Guthrie. I do not have the specifics of that FDA inspection 
report in front of me.
    I would like to get back to you if I could with more 
information in response to your question.
    Mr. Guthrie. OK. So we will go to warning letters. We will 
move to warning letters.
    It says, ``The warning letters are issued to achieve 
voluntary compliance. Warning letters are issued only for those 
violations that may lead to enforcement actions.''
    So after FDA's programmatic changes, FDA conducted nine 
foreign for-cause drug inspections that resulted in warning 
letters. Three of the nine letters, 33 percent, were issued 
more than 6 months after the inspection date.
    Were these facilities in the United States or within 
foreign countries like China?
    Ms. Grimm. Representative Guthrie, I do not have that 
report in front of me. I apologize. I cannot speak to it 
further for that report.
    Mr. Guthrie. OK. And so I have some other questions on that 
report. I guess I have to submit them for the record.
    So I do not know if you have this one or not. So your 
report notes that the FDA made programmatic changes, followup 
inspections at six OAI facilities that took an average of 460 
days versus the average of 329, at 11 OAI facilities.
    So you do not have that report in front of you either?
    Ms. Grimm. I do not have that report in front of me. I 
apologize.
    Mr. Guthrie. I thought that was part of the hearing today. 
I guess not.
    So I guess the question that gets back to the ORR, so the 
waivers that sped up that could have come from some of the 
sources that my friend--so they put waivers to process more 
children through the system.
    But those waivers resulted in some of the children getting 
to what we reported with slave labor and other types of issues 
moving forward. Is that not correct? If it was not for the 
waivers, that might not have happened?
    Ms. Grimm. The report on Fort Bliss, and I have been down 
to the border. I have visited multiple facilities over many 
years, and so I have seen firsthand what facilities are like.
    That report for Fort Bliss, it raises questions about the 
risk, the increased risk by these waived sponsor requirements 
and vetting processes. It does not reach a conclusion about 
whether any children were placed in unsafe households.
    We have an ongoing report that is looking at sponsor 
placement, and as I explained earlier, that report, I hope that 
that will be out in the next few months.
    Mr. Guthrie. So we do know children were placed in bad 
situations from ORR. We know that because we see the results of 
that happen.
    And so your report that you are working on is trying to see 
specifically what contributed them to being put in the 
situation where they were used for labor?
    Ms. Grimm. That report is looking more specifically at 
sponsor placement, at what requirements existed, whether those 
requirements were followed, and hopefully we will have some 
illuminating information on the results of some of those 
placements.
    Mr. Guthrie. But the requirements to look at, as Dr. 
Burgess said, is that their family members or someone, but not 
necessarily whether they have the right home, the right place, 
the right environment.
    I mean, you could find an uncle or an aunt that may not be 
the best person for that person to live with even though they 
are blood related, correct?
    Ms. Grimm. Correct, and that they could be placed with a 
family member.
    Mr. Guthrie. That is not the best circumstances, and we do 
not check those. Sometimes you can do everything. You can check 
everything you can check, and some people just do not show up 
being not in the best situation.
    But if you do not check the situation, you obviously can 
put them in a bad situation.
    Ms. Grimm. One of the waived requirements was waiving 
looking at certain categories of sponsors and the adults that 
lived in the household with those sponsors. That is something 
that we identified as an increased risk for a child being 
placed with an unsafe sponsor and an increased risk for 
trafficking issues.
    Mr. Guthrie. Thank you. My time has expired.
    I will yield back.
    Thank you for your answers.
    Mr. Griffith. The gentleman yields back.
    I now recognize the gentleman from New York, Mr. Tonko, for 
5 minutes.
    Mr. Tonko. Thank you, Mr. Chair.
    Federal health agencies are on the front lines when it 
comes to public health crises like that of the COVID-19 
pandemic. They provide crucial guidance and resources, and 
maintaining public trust in health agencies is essential, I 
believe, to protecting public health.
    President Biden and congressional Democrats have 
consistently acted to provide adequate resources for pandemic 
recovery and bolster government capacity to respond to emerging 
public health threats.
    The American Rescue Plan made critical investments in 
public health measures that provided necessary tools that would 
be able to enable us to combat the pandemic.
    And the Inflation Reduction Act will help us make real 
progress in the fight against climate change and deliver 
savings on energy and healthcare costs for our families across 
the country.
    These laws are also included--have included oversight 
provisions to make certain new programs would serve their 
missions while protecting against waste, fraud, and abuse. What 
is troubling is hearing some of our Republican colleagues sow 
confusion and fear that fosters distrust in science and 
scientific research. This is counterproductive to the work that 
we must do to learn from the past and prepare for future 
disease outbreaks.
    With that, Ms. Grimm, your office is partly responsible for 
making certain that HHS is spending its resources as Congress 
intended and implementing programs effectively. How does your 
office's oversight work help increase Americans' confidence in 
the services upon which they rely?
    Ms. Grimm. Well, specific to grants, OIG's review of NIH's 
EcoHealth report and OIG's grants oversight work generally is 
taking a look at whether or not appropriate controls exist, 
expenditures are appropriate, whether controls like reviewing 
reports are followed.
    Getting those basics right is critically important and 
better ensure that funds that are spent through grants for 
intramural research, that Americans get the benefit of what 
those research grants are intended to do.
    Mr. Tonko. Is that information exchanged with the public?
    Ms. Grimm. I'm sorry, Representative Tonko. Is what 
information?
    Mr. Tonko. The quality parameters that you establish to 
make certain that the dollars are being effectively invested, 
does that get exchanged in building that public confidence?
    Ms. Grimm. I believe that information related to grant 
expenditures is public. HHS grants in 2022 amounted to $120 
billion in grants. Out of NIH, $30 billion were spent on 
grants.
    Our work really focuses in on things like grant fraud, 
unallowable costs, threats to research integrity, and poor 
controls in monitoring, and some of these things, while they 
sound bureaucratic, are precisely the kinds of things we looked 
at in the EcoHealth report and found shortcomings that were 
very concerning related to high-risk research.
    If basic things like reviewing reports, if basic things 
like following up on late reports were done, we would have had 
better confidence in the kind of research that was being done.
    Mr. Tonko. And as you mentioned in your testimony, we will 
soon be in a new phase of recovering from the COVID-19 pandemic 
as the public health emergency comes to an end. Based on the 
work that your office has done, can you summarize some of the 
most important lessons learned that could help Congress and HHS 
prepare for future pandemics?
    Ms. Grimm. I can. Because this hearing was very wide 
ranging, I have a lot of material in front of me.
    But there are a lot of things that we have learned from 
pandemic spending. There are four lessons that I would zero in 
on.
    When funds are rushed out to address emergency needs, it 
may mean that more needs to be done after the fact to recover 
misspent funds and build in additional controls as soon as 
possible if that program is ongoing.
    For instance, HRSA that administered the Provider Relief 
Funds stood up a program very quickly, and we have recommended 
now that they go back and that they do more to look at payments 
to see if they were appropriate.
    They are only looking at 2 percent, which is something they 
decided to do deliberately to get money out the door. Even in 
emergencies, it is important to begin as many program integrity 
safeguards as possible.
    Inspectors General can and have provided technical 
assistance and insights based on past work for the American 
Rescue Program and for other programs.
    Broad, governmentwide approach is useful. So the Pandemic 
Response Accountability Committee, we know that if somebody is 
taking advantage of idle funds, paycheck protection funds, they 
are also likely taking advantage, and we have seen this, of 
provider relief funds as well.
    And improved data analytics. We need to do a better job of 
ensuring that data exists and is exchanged across partnerships 
so that we can more readily and rapidly detect and respond to 
improper payments and fraud.
    Mr. Tonko. Mr. Chair, I had other questions that I will get 
to the committee and subcommittee, and with that I yield back.
    Mr. Griffith. I thank the gentleman.
    I now recognize the gentleman from South Carolina, Mr. 
Duncan, for his 5 minutes of questions.
    Mr. Duncan. Thank you, Mr. Chairman.
    Inspector General, you all are busy.
    Ms. Grimm. Yes.
    Mr. Duncan. You have got a lot of work to do.
    I am going to submit for the record, there are five 
requests from the Protect Public's Trust for request for 
investigation on a number of things, and I would love for the 
IG's Office to respond on how those are progressing and whether 
they are even being addressed.
    Last month CBS News reported about suspected double billing 
concerns within the EcoHealth Alliance, an NIH grantee, related 
to its grant from the U.S. Agency for International 
Development, USAID. According to this report, it appears the 
USAID OIG had opened an investigation.
    Has your Investigations Office reached out to USAID's IG 
Office on this matter?
    Ms. Grimm. I cannot comment, Representative, on any ongoing 
investigations. We are aware of----
    Mr. Duncan. Are you all also looking into it?
    Ms. Grimm [continuing]. We are in contact with USAID.
    Mr. Duncan. You all are also looking into it as well?
    Ms. Grimm. We are aware and we are in contact with USAID.
    Mr. Duncan. So in addition, USAID, you are just letting 
them run with it and you are not. You do not have your ongoing 
investigation then?
    Ms. Grimm. I am not in a position to confirm or deny the 
existence of an ongoing investigation, Representative.
    Mr. Duncan. Thank you.
    According to NIH documents obtained by U.S. Right to Know 
under the Freedom of Information Act, the OIG concluded its 
investigation into EcoHealth Alliance in January of 2021, about 
4 months after it was opened, a 4-month investigation.
    Just for my understanding, is this investigation the same 
as the audit you recently conducted, or are they two separate 
efforts?
    Ms. Grimm. Representative, I will bring you through a 
process that our organization has. When something is referred 
to us, we have our executives that consist of our Deputy for 
Investigation's evaluation on it. We meet weekly to discuss 
certain referrals and decide where the best placement is for 
some of these allegations.
    The decision was made to do a grants oversight review of 
EcoHealth, and I think that we have found very important gaps 
in grants management.
    I would not characterize an investigation with----
    Mr. Duncan. So let me ask you this: If your investigation 
ended in January of 2021, why did you not issue the audit 
findings until this January 2023?
    Ms. Grimm. I would not characterize--or, I would not agree 
with that characterization.
    Mr. Duncan. Two years?
    Ms. Grimm. I would not agree with that characterization, 
Representative. We decided the----
    Mr. Duncan. The dates do not lie, ma'am.
    Ms. Grimm. I am sorry?
    Mr. Duncan. The dates do not lie. You ended your 
investigation January of '21, released the audit findings in 
January of '23.
    Ms. Grimm. We do not comment on ongoing investigative 
matters. So I would not----
    Mr. Duncan. So this is still ongoing then?
    Ms. Grimm. We do not comment on ongoing investigations.
    Mr. Duncan. OK. Well, I am going to take that as a yes 
because you issued your audit findings in January of 2023, but 
you cannot answer my question. So I am going to assume it is 
still going on.
    Four months is an extremely short time frame for an OIG 
investigation. Why did your office close this investigation so 
soon when more and more documents were coming out on EcoHealth 
grants?
    Ms. Grimm. Our EcoHealth report reviewed 7 years' worth of 
documentation, grants, guidance, emails. If we were to have 
found something that warranted an investigation, we would refer 
that over to our Office of Investigation.
    Mr. Duncan. OK. But apparently the investigation is still 
ongoing because you cannot answer questions about it. So I am 
assuming that you found more than 7 years' worth. Would that 
not be a good assumption?
    Ms. Grimm. Representative, I cannot comment on the 
existence----
    Mr. Duncan. Last question on this issue.
    Ms. Grimm [continuing]. Of an ongoing investigation, 
whether it exists or it does not.
    Mr. Duncan. With respect to this audit of EcoHealth, is it 
true that NIH only permitted your audit teams to review already 
produced FOIA documents?
    Ms. Grimm. I do not believe that that is accurate. The 
access rights for OIGs are incredibly broad. We have access to 
materials that are, I believe, beyond what FOIA would allow.
    Mr. Duncan. What other documents did your team review as 
part of that audit?
    Ms. Grimm. For EcoHealth Alliance?
    Mr. Duncan. Yes.
    Ms. Grimm. We reviewed 7 years' worth of grants information 
for EcoHealth grants. We reviewed three grants. One of those 
was for the Wuhan Institute of Virology. We reviewed all grants 
guidance. We reviewed emails, correspondence----
    Mr. Duncan. So there was a grant directly to Wuhan 
Institute of Virology?
    Ms. Grimm. Not from NIH. They were a subaward of EcoHealth.
    Mr. Duncan. OK. Mr. Chairman, I yield back.
    Mr. Griffith. I thank the gentleman.
    I now recognize Mrs. Lesko of Arizona for her 5 minutes of 
questioning.
    Mrs. Lesko. Thank you very much, Mr. Chairman.
    And thank you for your work. It is so important that we 
identify fraud and waste and U.S. taxpayer dollars being spent. 
So thank you and your staff.
    I am from a border State, Arizona, and I am on the Border 
Security Caucus here in Congress. I have visited the border 
multiple times. In my visits and in speaking to Border Patrol 
officers and local Arizona elected officials along the border, 
they have told me there is no vetting of the adults where 
immigrant children are being sent, and that girls are being 
placed in homes where they are sold into sex slavery.
    This is horrifying. This is horrifying if we are letting 
this happen.
    There was a memorandum of agreement put in place in 2018 
between Department of Homeland Security and HHS that agreed to 
have a process for vetting who unaccompanied migrant children 
would be released to. I have been told that HHS and DHS changed 
the MOA after the Biden administration took over in 2021, and 
it removed the vetting requirement.
    In addition, according to reports, ORR does not have the 
ability to track released children and, I quote, ``could not 
reach more than 85,000 children 1 month after they were placed 
with an adult.''
    This is alarming, I mean really alarming what we are 
allowing to happen to young children.
    First question is, are you familiar with this change in the 
memorandum of agreement between DHS and HHS?
    Ms. Grimm. Vice Chair Lesko, I appreciate your question. We 
have made recommendations for better MOUs between DHS and with 
DOJ. I am not familiar with that A, that specific change. We 
are happy to take a look at that and get back to you.
    Mrs. Lesko. My next question is, how are sponsors vetted 
now?
    Ms. Grimm. That is a great question, Vice Chair Lesko. I do 
not have at my fingertips the exact guidance that is now being 
used to vet sponsors. That would be a better question to ask of 
ORR.
    I can tell you, though, that our report looking at vetting 
of sponsors will illuminate hopefully what risks exist in 
placing children with sponsors and what risk exists with the 
current processes being used to vet sponsors.
    Our reports have consistently recommended rigorous vetting 
of sponsors.
    Mrs. Lesko. Well, I hope somebody listens to your 
recommendations because this is truly alarming. It is truly 
alarming if the United States of America is allowing girls to 
be sold into sex slavery and not vetting who we are sending 
these people to.
    So thank you for your investigation on that.
    I have a question, changing subjects a bit. The HHS Health 
Resources and Service Administration manages the 
Countermeasures Injury Compensation Program called CICP. It is 
charged with compensating those injured by the COVID-19 
vaccinations.
    Very few cases, however, have been approved for 
compensation, and many cases have been sitting for a couple of 
years now.
    Has your office looked into the operation and efficiency of 
this program?
    Ms. Grimm. Representative Lesko, we do have work that looks 
at the Provider Relief Fund and the uninsured funds. Both are 
programs that are administered by HRSA.
    We have work looking across many different audits that are 
touching about 50 percent of payments that have gone out from 
HRSA. Accuracy of payments in many instances would look at 
whether or not they were appropriately approved or 
appropriately denied.
    I am not familiar with this specific type of claim. Let us 
look at what our ongoing work is looking at, and we will get 
back to you to see if this is touched on.
    Mrs. Lesko. Thank you very much.
    My time has expired, and I yield back.
    Mr. Griffith. I thank the gentlelady for yielding back.
    I now recognize Ms. Cammack of Florida for her 5 minutes of 
questioning.
    Ms. Cammack. Thank you, Mr. Chairman. I appreciate it.
    Thank you for being here today.
    One of the top implemented recommendations in the OIG's 
2022 report was ACF and HHS should improve their operational 
management and communications systems to better address the 
safety and security needs of unaccompanied children.
    Has the ACF and HHS implemented this recommendation yet?
    Ms. Grimm. Thank you for your question, Representative 
Cammack.
    We are in receipt--we just got it yesterday--of ACF's 
response to our recommendations. I believe that's included in 
there.
    We are reviewing their response. We need to look at 
documentation. We consider it open until we have a chance to 
review it, but it looks like what they are providing, if they 
can substantiate it, we would clear that recommendation.
    Ms. Cammack. So no.
    Ms. Grimm. Open right now. It is open right now.
    Ms. Cammack. OK. So I think collectively, all of us in this 
room, we find this failure, the no, the implementation of the 
recommendation frustrating. I am not quite sure why something 
like this has not been implemented, but it is good to know that 
HHS acknowledges that this is a problem, especially given the 
fact that ORR's unaccompanied minor program has received record 
funding for the past couple of years.
    Your 2022 report on the top unimplemented challenges notes 
that ORR is working on a, quote, ``emergency policy development 
protocol that provides input from staff with expertise in child 
welfare whenever ORR develops and reevaluates existing policies 
and field guidance.''
    Do you know when this protocol came into effect? And was 
this protocol in effect at Fort Bliss and other emergency 
intake sites?
    Ms. Grimm. I do not know whether it was in place at 
emergency intake sites, but it was something that we 
recommended. It is something that ACF agreed with. It is 
something that they are claiming that they have addressed, and 
we are reviewing documentation.
    Ms. Cammack. Would you provide feedback to the committee on 
getting an answer on this, whether it was or not, because you 
said you are not sure?
    Ms. Grimm. Well, we need to get their paperwork and review 
it, and we will get back to you on whether or not we are 
considering it closed.
    Ms. Cammack. OK. So looking at the annual report, reading 
between the lines of the annual report, it appears that your 
office thinks that this protocol is inadequate. Can you explain 
why the protocol did not close out the recommendation?
    Ms. Grimm. So throughout the course of our ORR work, we 
have found challenges with horizontal and lateral 
communication. By that I mean communication across other 
Departments, with DHS, with DOJ. We found problems with there 
being lateral communication within ORR so that concerns that 
are raised by field specialists, for instance, are not being 
listened to by those higher up.
    So there are a number of things that ACF can do to address 
this, but it has not been addressed to our satisfaction.
    We find that this is a continuing issues across different 
administrations, where somebody in the field knows that census 
is going up. They do not have that. They are concerned about 
mental health issues. They are raising concerns----
    Ms. Cammack. I understand.
    I'm going to shift gears here because my time is running 
out. In the January 2023 HHS OIG report documenting how the NIH 
and EcoHealth Alliance failed to supervise the use of taxpayer 
funds at the Wuhan Institute of Virology, further the Wuhan Lab 
refused to provide lab notebooks and electronic files of a key 
experiment to EcoHealth.
    The NIH terminated the Wuhan Institute of Virology as a 
subgrantee then at that point. The OIG report concluded that 
NIH should, quote, ``consider whether it is appropriate to 
refer WIV''--Wuhan Institute of Virology--``to HHS for 
debarment.''
    The HHS OIG could refer the Wuhan Institute for debarment. 
That is correct?
    Ms. Grimm. That is what we are doing in the report. We are 
recommending that they consider whether or not they should be 
suspended or debarred.
    We do not have that authority. We make referrals over to 
the Department.
    I will mention we have reports in this area about 
suspension and debarment too.
    Ms. Cammack. And thank you for that quick answer.
    So then with that, has your office followed up to see if 
NIH will refer the Wuhan Institute of Virology to HHS for 
debarment?
    Ms. Grimm. Their response is not due until July on that 
report. It is my understanding that they are considering 
suspension, debarment.
    Ms. Cammack. Thank you.
    My time has expired. Mr. Chairman, thank you.
    Mr. Griffith. The gentlelady yields back.
    I now recognize the gentleman from Texas, Mr. Crenshaw, for 
5 minutes of questioning.
    Mr. Crenshaw. Thank you, Mr. Chairman.
    Thanks for being here.
    One of my big concerns is, you know, is if the excessive 
and increased funding that we are giving HHS is being spent 
wisely. There are a couple of areas I want to focus on.
    One is the FDA. Approval time for new cancer treatments is 
remarkably long, an average of 7 to 12 years.
    HHS's handling of refugee settlement, that is another 
problem I want to talk about.
    Some of these NIH grants, though, this is a topic near and 
dear to me where, you know, we have a major budget increase for 
cancer research but not a clear direction from the 
administration on how we are speeding up approvals of new cures 
and therapies.
    So do you know what portion of NIH funding goes to cancer 
research?
    Ms. Grimm. My understanding is it is $7.6 billion on 
cancer-related research out of NIH.
    Mr. Crenshaw. Yes. And how in the weeds does your office 
get in figuring out how that is spent and then developing 
metrics for how effective that money is spent?
    Ms. Grimm. We do not have any ongoing, Representative 
Crenshaw, work looking at cancer research out of NIH.
    Mr. Crenshaw. OK. I would urge you to. I mean, let's look 
at childhood cancer drugs, for instance. On average, 6\1/2\ 
years longer than the approval for adult cancer drugs. You 
know, why? That would be a great question to ask. If we are 
going to increase funding for NIH and FDA, we should know what 
we are getting for it.
    But the IG does not have any opinion on this, whether we 
are using those funds effectively at all?
    Ms. Grimm. We just do not have any ongoing work looking at 
it. I would love for my folks to come up and talk to you about 
some of your concerns.
    We do have work looking at different processes that FDA 
has, including the accelerated pathway program, and we had some 
findings in that space. But we do not have anything specific to 
cancer research.
    Mr. Crenshaw. OK. So let's talk more broadly. So findings 
in that space, could you tell us about that?
    Ms. Grimm. Well, OIG's mission is to ensure that taxpayer 
dollars are spent appropriately, and so our work looking at 
grants management ensures oversight so that taxpayer dollars on 
grants and in the instance you are citing, grants specific to 
cancer research----
    Mr. Crenshaw. No, no, I said talk more broadly. You said 
you had findings in the space of the accelerated approval 
program. What were the findings?
    Ms. Grimm. Oh, I am sorry. So that report looked at this 
process where they can approve drugs, but then they can have 
confirmatory trials later.
    We looked at the extent to which confirmatory trials were 
happening. Now, that does not mean that the safety is 
compromised, but the confirmatory trials are meant to look at 
the efficacy that is promised by the drug.
    We did find, I believe, I believe roughly a third of those 
confirmatory trials were late, and a handful of confirmatory 
trials were late between 5 and 10 years.
    So as a general matter, what OIGs do is take a look at 
whether there is adherence to requirements. We do not set 
policies. I cannot force FDA, CMS, NIH to take the 
recommendations we make. We make recommendations, and they 
decide to take them or not.
    But in that report, we looked at whether they were or how 
they were following their rules and the time that it took for 
these confirmatory trials to happen.
    Mr. Crenshaw. Yes. There are also many roles surrounding 
the extent to which the FDA has to communicate with its 
customer, whoever is seeking drug approval. Have you done an 
investigation on how effective that communication is and the 
quality of communication?
    Because that is my number one complaint I hear about. It is 
like a black hole. They cannot get answers from the FDA. They 
have timelines for their investors for their products, and they 
cannot get a single answer from these people.
    Is there any investigation ongoing in that regard?
    Ms. Grimm. We have work looking at approval of drugs that 
would include Aduhelm for Alzheimer's, and we are looking at 
the extent to which there was communication with external 
partners.
    Now, in that instance, we would be looking at whether or 
not there was inappropriate types of communication. Would it be 
appropriate for us to come up and talk to you about some of 
your concerns about communication and see----
    Mr. Crenshaw. I'm looking for, you know, their effective 
communication, productive communication. That would seem to 
fall right in line with handling taxpayer dollars effectively.
    If we are going to pay an agency to approve drugs, it 
should actually have an effective process for approving drugs 
instead of whatever it is doing now. And your office seems well 
positioned to maybe focus on that. I would love to talk more 
about it.
    And I yield back. Thank you.
    Mr. Griffith. The gentleman yields back.
    I now recognize the gentleman from California, Mr. Ruiz, 
for his 5 minutes.
    Mr. Ruiz. Thank you.
    Thank you for joining us today, Inspector General Grimm. I 
appreciate your office's consistent attention to the quality of 
the care that that unaccompanied children receive in ORR 
facilities.
    I remain deeply concerned about the treatment of 
unaccompanied minors who are fleeing dangerous situations and 
seeking refuge in the United States. These children are often 
forced to flee their homes due to violence, poverty, and 
persecution, leaving behind everything that they have ever 
known.
    I have seen firsthand the conditions these children arrive 
in. They arrive at our borders with little more than the 
clothes on their backs and are often traumatized by their 
experiences and their journey.
    It is our responsibility to ensure that these children are 
treated humanely and provided with the necessities they need to 
survive.
    I have previously introduced legislation, the Humanitarian 
Standards for Individuals in Customs and Border Protection 
Custody Act, that would work to ensure that immigrants coming 
to the United States to seek asylum are met with basic 
humanitarian standards, making sure that they have adequate 
food, water, sanitary conditions and health screenings for 
survival.
    Inspector General Grimm, your office has issued an 
extensive report on conditions at one ORR facility, the 
emergency intake site at Fort Bliss, where you outlined a 
number of necessary improvements.
    Could you provide us with an update on whether you have 
seen improvements at that facility and other intake sites?
    Ms. Grimm. We provided five recommendations for the Fort 
Bliss site. We are in receipt of ORR's response to that report. 
We are reviewing documentation to determine if the 
recommendations related to securing qualified case managers, 
that these case managers get comprehensive training and 
support, that emergency policy development protocol to allow 
for input from staff with expertise in child welfare, for 
usability and search capacities within the UC Portals, and for 
ORR employees and contractors and grant recipients to be 
informed about whistleblower protections.
    Mr. Ruiz. And has any of that been implemented?
    Ms. Grimm. They are claiming that they have taken steps to 
address all of our recommendations.
    Mr. Ruiz. But you have not seen the changes?
    Ms. Grimm. And we are reviewing the documentation. We just 
got it, I believe, yesterday.
    Mr. Ruiz. So having examined the Fort Bliss intake site in 
such detail, what resources do you think your office or 
Congress can provide to ensure that unaccompanied children are 
treated humanely while in ORR custody and provided with the 
necessary medical services they might need?
    Ms. Grimm. Well, we are--I am trying to find--I am sorry--
our request for resources.
    We are falling behind, Representative, in our ability to 
keep pace with the growing number of programs at HHS. The 
President's budget for fiscal year 2025, if implemented, would 
provide OIG with much-needed resources.
    We have a legislative proposal in there in A19 that would 
rebase the Healthcare Fraud and Abuse Control Act. We have a 
request in for additional resources to provide oversight for 
the over 100 programs outside of Medicare and Medicaid.
    We have not kept pace.
    Mr. Ruiz. OK.
    Ms. Grimm. We have less than 2 cents for every $100----
    Mr. Ruiz. So clearly, there's more resources that are 
needed.
    Ms. Grimm. Yes.
    Mr. Ruiz. Now I want to turn to the importance of 
postrelease services. Children can require a range of 
postrelease services, depending on their individual needs. Many 
of these minors have experienced violence, abuse, and neglect 
and require specialized care and support to heal from their 
trauma.
    Recent reports indicated that there is some inconsistency 
of services available to children after they have been placed 
by ORR with a sponsor.
    While I am pleased to see that HHS has committed to the 
goal of extending postrelease services to all children after 
release from ORR care within 2 years, I want to be sure that 
ORR has the proper resources, training, equipment, and staffing 
they need to meet these children's needs.
    Based on OIG's past or ongoing work, could advancing 
efforts to provide postrelease services have a positive impact 
on the safety and well-being of the unaccompanied children who 
have been placed in the care of a sponsor?
    Ms. Grimm. We do not have any ongoing work looking at 
postplacement services. We do have some ongoing work looking at 
transfers across different ORR types of facilities.
    I believe that would include specialized services, mental 
health services.
    Mr. Ruiz. Well, HHS has committed to the goal of extending 
postrelease services, postrelease services to all children 
after release from ORR care within 2 years.
    So I think that we should go back and sense what that 
commitment is, what is necessary to be productive members of 
our society, as there's issues that--from trauma that can lead 
individuals into behaviors that are harmful to themselves and 
to others.
    And so that is why we need to address the post-traumatic 
stress. We need to address the sense of belonging, the sense of 
wellness in early age in order to maximize the wellness and 
productivity of those children when they become adults.
    Thank you.
    And with that, I yield back.
    Mr. Griffith. The gentleman yields back.
    And now if the witness will be so kind, we are going to 
have some wrap-up questions by both the ranking member and 
myself.
    And I recognize Ms. Castor for her followup questions.
    Ms. Castor. Thank you, Mr. Chair.
    And thank you, again, to the Inspector General for being 
here.
    In your testimony to us, you say on protecting healthcare, 
``Decades of HHS OIG enforcement and oversight proved the adage 
that fraudsters follow the money.''
    When looking at a number of the CMS initiatives that are 
administered with the States and private insurance companies, 
you say ``program risks in Medicare and Medicaid can have huge 
impacts on enrollees and their access to necessary care and 
potentially result in improper payments that cost taxpayers 
hundreds of millions of dollars.
    ``OIG's oversight of the Medicare Advantage Program is a 
key example. Over the past 10 years, Medicare Advantage 
enrollment has increased significantly. It now now covers more 
than 30 million Medicare enrollees and is expected to cover 50 
percent of all enrollees soon.''
    But you say this rapid expansion has put program integrity 
and highlighted serious issues with compliance weaknesses with 
managed care plans: inflated payments to plans, enrollees with 
serious medical conditions that may not receive the needed 
care. And this kind of tracks with what I hear as a Member of 
Congress trying to do constituent service. If they are enrolled 
in Medicare Advantage, I do not have as much influence on 
rectifying a situation as I do with traditional Medicare.
    And you say, ``Our work has also raised concerns regarding 
improper denials of Medicare covered services. Our work 
demonstrates that the risk of fraud, waste, and abuse in 
managed care are real and significant.'' They ``not only 
threaten the financial integrity of Medicare, but also 
potentially affect enrollees' healthcare.''
    So what ongoing work are you doing now to combat fraud and 
abuse in Medicare Advantage? There are a number of reports out 
there highlighting these issues as well.
    What is the ongoing oversight by the IG?
    Ms. Grimm. Thank you for this question, Ranking Member 
Castor.
    When I talk about my priorities, there are two issues that 
I always highlight: nursing homes--improving the care in 
nursing homes and protecting residents in nursing homes--and 
program integrity in Medicare Advantage.
    We have completed a number of reports. You just walked 
through a few of them, and we see issues with inflated risk 
scores. We have concerns that serious conditions, things like 
acute stroke, congestive heart failure, serious mental 
conditions that include bipolar disorder, plans that are 
getting increased risk score payments and we are not seeing 
commensurate services flowing from those diagnoses.
    It is serious and real because on the Medicare side we are 
approaching 50 percent of our Medicare population being served 
by Medicare Advantage.
    Some of the fraud that we see, in some instances 
beneficiaries do not even know that they are involved in 
Medicare Advantage. We are seeing improper denials of services, 
and when we go in and we take a look at those denials, we are 
seeing that they would have been paid for on the Medicare side.
    This presents concerns around access because, if your 
payments are denied, you have to take extra steps. Providers 
do, beneficiaries do. It creates friction in the program.
    I just spoke at a RISE Conference out in Colorado Springs 
about some of our compliance concerns, and we have a call to 
action for Medicare Advantage industry to better policing 
themselves.
    We are encouraging self-disclosure of inappropriate 
conduct. We desperately need more resources to get boots on the 
ground to take a look at what we are seeing as concerning, 
whether or not it is actually fraud, whether there are 
conspiracies on the part of plans to take advantage of 
loopholes in programs, whether that is, indeed, fraud.
    So that is an area if we were to get increased resources 
where we would really like to get to ground on whether or not 
these concerns actually result in fraud.
    Ms. Castor. And here we have all of the Baby Boomers 
retiring. It is stressing Medicare, and we have got a 
responsibility--the IG does, HHS does, and the Congress does--
to ensure that the dollars are going appropriately to 
healthcare services and not to fraudsters. So I think that is 
an area ripe for Oversight and Investigations as well.
    So thank you very much.
    Mr. Griffith. I thank the gentlelady.
    So let's clear up a couple of things. First, one that I do 
not know the answer to but I ought to, and I have not heard it 
mentioned today. When you were talking with Mr. Ruiz, Dr. Ruiz, 
earlier and you were talking about postplacement services and 
that kind of thing, one of the questions that entered in my 
mind earlier with other questions and with Dr. Ruiz is, Is ORR 
notifying the local Department of Social Services that a child 
has been placed in their area?
    And the reason I ask that is that we see these reports 
where kids are not being educated. They are not in school. They 
are having to work these long hours. A lot of times your 
Department of Social Services will check up on a kid to see, 
``OK. We know that Little Johnny arrived here. How come they 
did not enter into the West Salem Elementary School? Why are 
they not in the middle school?'' And they can follow up on 
that.
    Are we doing that? Are we notifying them?
    Ms. Grimm. Chairman Griffith, I do not know the answer to 
that question if ORR is notifying local officials.
    Mr. Griffith. Can you find out for me?
    Ms. Grimm. I will look into that, yes.
    Mr. Griffith. All right. You can look into that, and I will 
look into that further as well.
    Also, I think there may have been some misunderstanding. 
When you were talking to Ms. Cammack, you indicated on Wuhan 
Institute of Virology that you had recommended the NIH 
disbarment or debarment.
    Ms. Grimm. That they consider.
    Mr. Griffith. Right. But do you not have the authority to 
go directly to HHS's money folks and recommend to them as 
opposed to going through NIH? Go straight to HHS and say, ``We 
recommend they be debarred.''
    Ms. Grimm. We make referrals to the office that handles 
suspension and debarment. In fact, we did a report on that.
    Mr. Griffith. And did you send Wuhan up to them as well 
besides making a recommendation to? Did you make a referral to 
HHS as well as a recommendation to NIH?
    Ms. Grimm. I do not believe so.
    Mr. Griffith. All right. And so the question that then 
comes to me is, Have you done that with EcoHealth Alliance?
    Ms. Grimm. In our report, we do not recommend suspension 
and debarment.
    Mr. Griffith. OK. So I have got to ask why because we know 
that EcoHealth was delayed on year five. We know that in year 
four they delayed reporting in year four excessive virus growth 
on their progress report to the NIH.
    They violated their contract because they did not get the 
information from the Wuhan Institute of Virology--and look, we 
will never know now. Because we did not get those reports, we 
will never know what they were doing at that point in history 
and whether or not something bad was about to happen inside the 
lab.
    And whether you are a believer that it was a lab leak that 
caused COVID-19 or whether you think it was an animal, that 
information would be critical in a virus that killed millions 
of people around the world to have.
    EcoHealth Alliance violated their contract. They were 
negligent, they were sloppy, and they did not do their job. Why 
in the world would we not debar them?
    Ms. Grimm. Our report does not recommend suspension and 
debarment.
    Mr. Griffith. Why? With all of these violations, not just 
they did not do one. They did two or three things that I 
consider major violations of their contract. So why are we not 
debarring them?
    Ms. Grimm. Our auditors that did this work have to adhere 
to Yellow Book standards, professional standards. Their 
analysis did not, in their view, warrant a recommend----
    Mr. Griffith. Are they lawyers or scientists, or do you 
have a combination?
    Ms. Grimm. They are auditors, and our work is reviewed by 
attorneys.
    Mr. Griffith. OK. Well, I have just got to tell you I see 
this kind of a breach as an attorney. I see this kind of a 
breach. I ain't doing business with those people anymore, and 
it drives me crazy that we are spending the American taxpayer 
dollars with a company--we are currently spending money with a 
company that negligently handled the records related to 
coronavirus research being done at the Wuhan Institute of 
Virology.
    And it is a plausible theory. I think it is clear and 
convincing evidence that it came out of the lab. I think it was 
an accident, but others may have different opinions. It does 
not matter.
    Either way if we had that information, we would have the 
ability to make a better decision on where this virus came from 
that killed millions of people in the world, and I do not 
understand why we are spending American taxpayer dollars 
supporting a company with that kind of a record.
    I yield back.
    Ms. Grimm. Chairman, can I----
    Mr. Griffith. Yes, ma'am. I will give you a minute. I went 
on a little tirade there. I will give you a minute to answer.
    Ms. Grimm. OK. The report points out a number of issues 
that the Department itself could take action and suspend and 
debar EcoHealth Alliance. We do not say they should not suspend 
and debar.
    We have another report that talks about the suspension and 
debarment program that was released a couple of years ago, and 
we found a number of opportunities.
    The majority of referrals come from us for suspension and 
debarment. We do not see referrals from CDC, from NIH, from 
ACF, from CMS, other grant-making contractor-giving officials, 
and we note that in our report.
    The Department could make a referral to that entity to look 
at whether or not they could be suspended and debarred, and we 
do point out in that separate body of work that there are more 
opportunities.
    We should not be the only ones recommending suspension 
and----
    Mr. Griffith. So you think we should expand the ability to 
make those recommendations.
    And do you think that we should have the ability for HHS to 
fine bad actors, to have a monetary penalty when they do not 
submit the reports that they are supposed to submit in a timely 
manner, particularly when you are dealing with deadly 
substances, pathogens?
    Ms. Grimm. Our work does not have any findings on fines. We 
do note that 90,000----
    Mr. Griffith. But you would not be against it if we in 
Congress decided we wanted to do that.
    Ms. Castor, I went over my time. Do you want another 
minute?
    Ms. Castor. No.
    Mr. Griffith. All right. OK. Thank you very much.
    Seeing that there are no further Members wishing to ask 
questions, I would like to thank our witness again for being 
here today.
    And pursuant to committee rules, I remind Members that they 
have 10 business days to submit additional questions for the 
record, and I ask the witness to submit her response within 10 
business days upon receipt of these questions.
    And without objection, the committee is adjourned.
    Thank you very much, ma'am.
    [Whereupon, at 12:20 p.m., the subcommittee was adjourned.]
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