Creator: Patrick Connole
HHS OIG: $658 Million in Potential COVID Relief Overpayments
It appears the feds overpaid some providers during the COVID-19 payment. HHS-OIG issued a report detailing what it found in a new probe.
HHS-OIG issued a report on Nov. 2 that said the Health Resources and Services Administration (HRSA) made $658 million in potential overpayments to selected providers under Phase 3 of the Provider Relief Fund (PRF) Program intended to supplant lost revenue and expenses tied to the COVID-19 pandemic.
While not naming exactly which providers it studied, HHS-OIG noted the healthcare sectors that received PRFs, including some $9.4 billion for SNFs. No nursing homes were named in the report, nor was the sector highlighted for any of the examples of potential overpayments (or underpayments) by HRSA.
Congress appropriated $178 billion to HHS to provide funds to eligible providers for healthcare-related expenses or lost revenues attributed to COVID-19. HRSA calculated providers’ Phase 3 PRF payments based on the greater of 2 percent of the providers’ patient care revenue or 88 percent of the providers reported net revenue losses.
HRSA distributed about $19.3 billion to 64,048 providers in the Phase 3 General Distribution, the report said.
“This audit is part of a series reviewing various aspects of PRF payments. Specifically, this audit assessed whether Phase 3 PRF payments that HRSA made to providers were correctly calculated, properly supported, and were made to eligible providers in accordance with PRF terms and conditions and federal requirements,” HHS OIG said.
“We reviewed a statistical sample of 150 providers and a nonstatistical sample of 15 providers who received Phase 3 PRF payments.”
Some of the reasons for the discrepancies in payments include incorrect information entered on providers’ PRF applications, incorrect patient care revenues, expenses, or both, incorrect loss ratio, or lack of appropriate documentation, the report said.
What OIG Found
The following are the takeaways from the report:
- For all 150 providers in the statistical sample and all 15 providers in the nonstatistical sample, HRSA made PRF payments to providers who met federal eligibility requirements.
- However, for 65 of the 150 providers in the statistical sample, HRSA made PRF payments that were not correctly calculated or supported by appropriate documentation. For 7 of the 15 providers in its nonstatistical sample, HRSA made PRF payments that were not correctly calculated.
- HRSA made $655.7 million in potential overpayments to 39 providers and $131.3 million in potential underpayments to 26 providers in the report’s statistical sample. In addition, HRSA made $2.3 million in potential overpayments to six providers and $1.1 million in potential underpayments to one provider in the nonstatistical sample, HHS OIG said.
Investigators said they made two recommendations to HRSA, including that it conduct a review of the providers in the HHS OIG statistical sample that had potential overpayments of $655.7 million and the providers in our nonstatistical sample that had potential overpayments of $2.3 million and determine the amount of and seek from these providers repayment of any overpayments, up to $658 million.
HRSA did not indicate concurrence or nonconcurrence with the recommendations.
Read the full report at HRSA Made $658 Million in Potential Overpayments to Selected Providers Under Phase 3 of the Provider Relief Fund Program, A-09-23-01006.
Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.
