The Health Resources and Services Administration (HRSA) is seeking repayment of Provider Relief Fund (PRF) payments from providers who failed to submit the required report(s) on their use of the funds. Recipients were required to submit one or more reports to HRSA identifying their COVID-19 attributable expenses and revenue losses as a condition of receiving the PRFs.  In Final Repayment Notices (Notices) it has distributed, HRSA tells providers they are out of compliance and must return the payments within 60 days. On its PRF webpage, HRSA has a program update announcing the issuance of these Notices and links to a new Repayment and Debt Collection webpage.

The Notices reflect a new phase in the PRF program, with HRSA beginning to take enforcement action after focusing primarily on distributing payments to providers since April 2020.  Below we consider the substance of these Notices and the options should you receive one.

Final Repayment Notices

HRSA began sending Final Repayment Notices in December 2022, targeting providers who received one or more PRF payments exceeding $10,000 between April 10, 2020, and June 30, 2020, (referred to as Payment Received Period 1) and have not submitted a report on their use of the funds. HRSA issued many of the Payment Received Period 1 payments automatically using bank account and contact information on file with Centers for Medicare and Medicaid Services (CMS), resulting in direct deposit payments to all Medicare-enrolled providers and suppliers without any request for payment.

Under HRSA’s administration of the PRF program, providers that received and accepted PRF payments agreed to Terms and Conditions requiring the submission of a report to HRSA on the use of the payments. HRSA deemed providers that received PRF payments and did not return them within 90 days of receipt to have accepted the funds and agreed to the Terms and Conditions. The deadline to file a report on the use of funds received during Payment Received Period 1 was September 30, 2021, although HRSA gave providers a grace period through November 30, 2021.

HRSA outlines expectations for providers that receive Final Repayment Notices on its Repayment and Debt Collection webpage. Providers have 60 days from the date of the Notice to either return the payments or request a Decision Review to dispute the repayment request. Providers can use the Decision Review process to dispute HRSA’s repayment request and/or the amount of a repayment request. Requests must include supporting documentation and may be submitted using an online portal. Final Repayment Notices issued to providers in December 2022 have a deadline of February 7, 2023, to either repay the funds or request a Decision Review.

Providers who fail to take action in response to a Final Repayment Notice by the deadline may have their case referred to the Department of Health & Human Services (HHS) Program Support Center (PSC), which provides debt collection services for HRSA, and the U.S. Department of Treasury for debt collection.

PRF Reporting Deadlines

The reporting deadlines for PRF payments depend on when a provider received the funds and are as follows:

Period Payment Received Period
(Payments Exceeding $10,000 in Aggregate Received)
Reporting Time Period
1 April 10, 2020 to June 30, 2020 July 1, 2021 to September 30, 2021*
2 July 1, 2020 to December 31, 2020 January 1, 2022 to March 31, 2022
3 January 1, 2021 to June 30, 2021 July 1, 2022 to September 30, 2022
4 July 1, 2021 to December 31, 2021 January 1, 2023 to March 31, 2023
5 January 1, 2022 to June 30, 2022 July 1, 2023 to September 30, 2023
6 July 1, 2022, to December 31, 2022 January 1, 2024, to March 31, 2024
7 January 1, 2023 to June 30, 2023 July 1, 2024, to September 20, 2024

* Grace period ended on November 30, 2021.

Implications for Providers and Next Steps

Because HRSA deemed providers that received and kept the PRF payments to have accepted the Terms and Conditions, these notices may come as a surprise to some providers. Providers that receive a Final Repayment Notice should ensure they take action within 60 days to avoid debt collection practices, either by returning the funds or requesting a Decision Review. Given that HRSA issued many of the Payment Received Period 1 payments automatically, without requiring an application or request for payment, there may be Medicare-enrolled providers or suppliers who received PRF payments without understanding the PRF program requirements and reporting obligations.

All providers who have received PRF funds should confirm compliance with the program’s Terms and Conditions and reporting obligations. PRF recipients should also confirm whether they must comply with federal requirements to independently audit their use of federal awards (referred to as Single Audits). These independent audit requirements apply to entities that spend $750,000 or more in federal funds, including PRF payments, during their fiscal year. HRSA has also indicated that the agency may conduct audits of PRF recipients and require providers to repay PRF payments based on audit findings.

We will continue to monitor updates related to PRF reporting and repayment obligations and provide additional updates as released. If you have any questions about the PRF program, please contact the authors.