When COVID-19 hit the world like an earthquake, a nursing home that was halfway through its five-year quality-of-care corporate integrity agreement (CIA) was in a predicament. On the one hand, it had obligations to the HHS Office of Inspector General (OIG) stemming from its settlement of a False Claims Act case. On the other hand, “we were having death after death after death,” said Tamar Abell, CEO of TBA Compliance, who worked with the nursing home on its CIA. Because of the ravages of the COVID-19 pandemic, Abell called the OIG attorney overseeing the CIA and said, “We are not managing. We don’t have enough staff or body bags.” That set in motion a level of CIA flexibility that lasted about six months, and is emblematic of how enforcement and compliance have been different in some ways during the pandemic and how compliance programs have permanently changed, Abell said Nov. 8 at the Healthcare Enforcement Compliance Conference sponsored by the Health Care Compliance Association.^[1]