The Regulator

The HHS inspector general says the government may have overpaid 45 sampled providers by $658 million in the last phase of COVID relief grants, and wants it recovered. The Office of Inspector General (OIG) audit, report A-09-23-01006, reviewed Phase 3 of the Provider Relief Fund, the pandemic grant program run by the Health Resources and Services Administration (HRSA). HRSA paid about $19.3 billion to 64,048 providers in that round, using the greater of 2 percent of patient care revenue or 88 percent of reported net revenue losses. In a statistical sample of 150 providers, 65 had payments that were not correctly calculated or supported by documentation, with $655.7 million in potential overpayments to 39 providers and $131.3 million in potential underpayments to 26. A second sample of 15 providers added $2.3 million in overpayments to six and $1.1 million in underpayments to one. Who it hits: providers that took Phase 3 money and cannot document the revenue figures behind it. So what: OIG recommends HRSA review the overpaid providers and seek repayment of up to $658 million, and HRSA did not say whether it agrees, only that it described planned actions. Confidence: High on the figures, which come from OIG’s report page; Med on how much HRSA actually recovers, since a recommendation is not a demand letter. Sources: HHS OIG report A-09-23-01006.

UPDATE: CMS corrected its emergency notice on the home health pre-claim review demonstration today, and the comment deadline stays November 16. The Centers for Medicare & Medicaid Services (CMS) notice for CMS-10599, the Pre-Claim Review Demonstration for Home Health Services, ran in the Federal Register on November 2. Today’s correction removes one passage that began with the word “Providers” and ended with “Contractors,” and says the option it described “is no longer part of this information collection request.” Who it hits: home health agencies in the demonstration states, including California if the expansion we covered November 2 goes ahead. So what: the notice does not say what the removed option was, and every other part of the November 2 notice, including the 14-day comment window ending November 16, is unchanged. Confidence: High on the correction text; Low on what the dropped option was, because the correction does not say. Sources: Federal Register correction notice, 91 FR 69565.

Fewer than one in four Medicaid enrollees with hepatitis C got treated within six months of testing, and state rates ranged from 7% to 41%. The HHS inspector general report OEI-BL-24-00450, issued October 28 and posted November 2, found 23% of Medicaid beneficiaries with hepatitis C were treated within six months, and those who were treated typically started about seven weeks after testing. Rates were lower for newly infected people, people eligible for both Medicare and Medicaid, older adults and children. Who it hits: state Medicaid programs, managed care plans, and drugmakers selling hepatitis C cures. So what: OIG told CMS to build on the Medicaid hepatitis C quality measure that starts in 2027 and to target dual-eligible beneficiaries, who mostly get these drugs through Medicare; CMS agreed with both recommendations. The report page does not give the sample size or the years of data. Confidence: High on the findings; Low on dollar impact, which the report page does not state. Sources: HHS OIG report OEI-BL-24-00450.

Louisiana owes the federal government $2,690,745 for Medicaid managed care payments made on behalf of people in jail or prison. The OIG audit, report OAS-25-04-100, issued October 27 and posted October 29, checked 100 incarcerated enrollees and found unallowable capitation payments for 46 of them, totaling $143,459 ($102,822 federal share). Capitation payments are the flat monthly amounts a state pays managed care insurers per enrollee. OIG estimated unallowable payments of at least $3.7 million ($2.6 million federal share) over the audit period. Who it hits: Louisiana’s Medicaid agency and the insurers that were paid for people who should have been suspended from coverage. So what: OIG recommended a refund of the federal share and faster suspension of enrollment once incarceration is reported; Louisiana agreed with both and described actions already taken. Confidence: High; the figures come from OIG’s report page. Sources: HHS OIG report OAS-25-04-100.

Federal Register note: the only other health-related rule published today is a technical amendment from the Drug Enforcement Administration (DEA). It clarifies that the regulation on amending or withdrawing registration applications also covers renewal applications. Who it hits: DEA registrants. So what: it is a clarification, not a policy change, and the notice gives no cost. Confidence: High on the summary; the full text was not read. Sources: Federal Register DEA final rule, 2026-22484.