Nearly Half of Audited IHS and Rural Providers Misused $90 Million in COVID-19 Relief Funds

NOTE: The OIG report does not specify whether those 2 IHS facilities were among the 14 noncompliant providers or the 16 that passed clean. Federal accountability matters when taxpayer dollars are designated for Native health and rural communities.

OIG Audit Finds 14 of 30 Providers Failed To Comply With Provider Relief Fund Requirements

A February 2026 audit by the HHS Office of Inspector General (Report A-09-23-01001) found that 14 of 30 selected Indian Health Service and rural providers failed to comply with federal requirements for spending Provider Relief Fund payments. These 14 providers claimed $70.6 million in unallowable expenditures and $19.7 million in inaccurately calculated or unsupported lost revenues — a combined $90.3 million in misspent funds drawn from the $178 billion Congress appropriated to HHS for COVID-19 relief. HRSA concurred with all three OIG recommendations, including requiring providers to return unallowable amounts to the federal government.

Rural Hospital Systems Made Up 93 Percent of the Audit Sample

An important distinction for Our Relatives and Native populations reading this report: only 2 of the 30 audited providers were IHS-operated facilities, while the remaining 28 were rural provider systems that included hospitals across 20 states. Violations across the full sample included salary payments exceeding the federal Executive Level II cap of $199,300, $36 million in expenses unrelated to COVID-19, $20.4 million reimbursed by other funding sources, and $10.3 million in costs lacking adequate documentation!

What This Means for Indian Country and Native Health Funding

For elders, Native practitioners, and Indigenous communities served by Indian Health Service facilities and tribal health programs, every misallocated dollar represents culturally competent care that was never delivered. Of the 4,516 IHS and rural providers that received approximately $25.2 billion in PRF payments, this audit sampled just 30 — raising serious questions about broader compliance and federal stewardship of Native health resources.

Ellsworth Supports Accountability Across Indian Country

As an ISBEE-certified, Native owned small business, Ellsworth stands with Indigenous communities who depend on transparent, accountable federal funding. Culture awareness, fiscal integrity, and accurate reporting must guide every dollar designated for IHS facilities, tribal health programs, and rural providers serving Our Relatives.