Medicare Compliance & Reimbursement

Context: On March 7, OIG posted another report — this is the national watchdog agency’s fifth investigation and report on COVID-related PRF payments — that showed the HHS Health Resources and Services Administration (HRSA) miscalculated payments to certain Medicaid, CHIP, dental and assisted living providers. In a sample of 150 providers who received payments during the Phase 2 General Distribution, OIG uncovered payment issues with 17 providers.

“HRSA made PRF payments that were not correctly calculated (15 sampled providers) or were not supported by appropriate documentation (2 sampled providers),” the report says. This miscalculation resulted in “$18.4 million in potential overpayments,” which OIG recommends HRSA try to recoup from the providers, the report indicates.

Know this: Among OIG’s recommendations to HRSA, one that sticks out involves documentation and may be a harbinger for future PRF programs. OIG advises “should HRSA need to rapidly disburse similar payments to providers in response to a future national emergency, we recommend that HRSA consider taking specified steps (to the extent they are applicable) to safeguard taxpayer money, such as requiring providers to submit supporting documentation for all revenue information provided on applications for payments,” the report says.

In addition to the reports, OIG currently lists six Work Plan active audits of PRF payments, and in coordination with the Department of Justice (DOJ), continues to investigate and charge providers with PRF fraud.

Reporting Period 6 just ended on March 31 for PRF payments received between July 1, 2022 to December 31, 2022. Reporting Period 7 begins on July 1, 2024 and runs through Sept. 30, 2024 for funds received between January 1, 2023 – June 30, 2023.

Reminder: HRSA removed “Reporting Periods 8 and 9 line items to indicate the end of payment disbursements due to the Fiscal Responsibility Act,” the agency notes on its webpage.