-an incorrect ratio or variable was used when calculating payments;
-Standardized practices for calculating payments and deductions were developed, including leveraging pay files, systems, validating recipients for application-based payments, and exploratory analysis for determining and authenticating recipients’ payment history. Following these process changes, no discrepancy was found to affect later distributions.

-the revenues listed on the application did not trace to the documentation support provided
-HHS put in place a system that flags or triggers potential anomalies for further analytical review and investigation to correct potential error. Such as payment denial or modify documentation to explain why the anomaly is reasonable/accurate.

-an incorrect payment calculation was used due to an input error.
-HHS implemented a pre-payment control, such as manually validating high-dollar payments, and additional peer reviewers, to aid in identifying and correcting errors before payment disbursement.

As identified in the previous sections, corrective actions were undertaken to strive to eliminate payment calculation errors and supporting documentation deficiencies. HHS also improved audit and other post-pay reviews. HHS is recruiting additional staff to enable increased manual reviews in identifying a larger and more accurate population of recipients who potentially received improper payments.

Health Resources and Services Administration (HRSA) - Provider Relief Fund General and Targeted has NOT established a baseline.

The program's current year improper payment and unknown payment rate of 0.32 % may or may not be the tolerable rate. The agency has not yet determined the tolerable rate for this program.

PRF is a newly established program and is in its first year of reporting. HHS is unable to establish a baseline tolerable rate due to the need to gather multiple years of benchmark reporting data for which future comparisons can be made.

PRF is a newly established program and is in its first year of reporting. HHS is unable to establish a baseline tolerable rate due to the need to gather multiple years of benchmark reporting data for which future comparisons can be made.

Appendix C to OMB Circular A-123, this is not applicable as this is year one of reporting.

HHS continues to prioritize and implement effective corrective actions and mitigation strategies that reduce improper payments as evidenced by its two consecutive year of reductions in total overpayments made. Specifically, from FY 2022 to FY 2023, HHS decreased its error rate from 0.32% to 0.10% and improper payments from $409.48 million to $22.31 million ($387.17 million reduction). The actions taken and planned to address the underpayments are proportional to the severity of the associated amount, For example, HHS initiated the change to dollar amount for patient care revenue replacing the whole number percentages, which allowed greater precision by providers. Standardized practices for calculating payments and deductions were developed and continues to be improved upon, including leveraging pay files, systems, validating recipients for application-based payments, and exploratory analysis for determining and authenticating recipients’ payment history. HHS employs a system that flags anomalies for in-depth analysis and investigation to rectify potential errors or clarify why the anomaly is not an error.

As identified in the previous sections, corrective actions were undertaken to strive to diminish payment calculation errors and supporting documentation deficiencies. These process changes supports the low, nonmonetary, improper payments identified.

Health Resources and Services Administration (HRSA) - Provider Relief Fund General and Targeted has established a baseline.

HHS expects the tolerable rate to remain the same due to internal controls, corrective actions and mitigations put in place, and the reduction to future outlays as the program progressed.

The program's current year improper payment and unknown payment rate of 0.1 % has been achieved with a balance of payment integrity risk and controls and represents the lowest rate that can be achieved without disproportionally increasing another risk, therefore it is the tolerable rate.

HHS expects the tolerable rate to remain the same due to internal controls, corrective actions and mitigations put in place, and the reduction to future outlays as the program progressed.

HHS expects the tolerable rate to remain the same due to internal controls, corrective actions and mitigations put in place, and the reduction to future outlays as the program progressed.

HHS established standardized practices for calculating payments and deductions, involving pay files, systems, and verifying recipient eligibility and payment history through exploratory analysis. Additionally, as the program matures, HHS continues to implement means to record and track standards and guidelines throughout the program lifecycle to avoid confusion and alleviate discrepancies.

HHS has a robust risk management process to help identify threats, risks, vulnerabilities to the PRF program and implement controls to detect or prevent improper payments.

HHS continuously offers training to personnel and contractors on conducting payment disbursement audits and reviews, including resolution, covering federal laws and internal policies.

HHS did not submit any specific budget requests for the PRF program. Rather, the HHS recent budget submission is on HHS-wide activities and program support as it relates to PRF. HRSA made payments until June 2023, when the remaining unobligated funds for provider relief payments were rescinded.

From FY 2022 to FY 2024, HHS decreased its error rate from FY 2022 0.32%, FY 2023 0.10% and FY 2024 0.06% and improper payments from $409.48 million to $22.31 million and now $3.78 million in 2024 respectively. The vast majority of payments were completed before we started testing or knew any results. After our first year of testing, the target we set for the second year was to maintain the same rate because the number of payments issued significantly decreased.

The corrective actions taken to address payment calculation errors and supporting documentation deficiencies have been effective, as evidenced by the low improper payment rate and minimal non-monetary loss to the government discovered during testing. For instance, HRSA implemented post-payment reviews, audit strategies, reporting mechanisms, and system enhancements to bolster detection measures and ensure payment integrity. HRSA also rectified improper payments by making subsequent payments to affected providers with the accurate data, thereby ensuring that the correct total payments were issued to the provider.

The actions takenby HRSA were focused on the causes of the improper payments in the PRF program because the varied assistance was targeted to address the three root causes of error identified. In FY 2024 PRF improper payments were due to:
•input errors when calculating payments.
•Provider was paid for expenses and/or losses that were reimbursed by other sources' could not be tested as the source documents
•incorrect calculations as a result of the utilization incorrect percentage attributable to patient care revenue.

As the PRF program advanced, standardized procedures for calculating payments and deductions were established. These practices involved using pay files and systems, verifying recipients for application-based payments, and conducting exploratory analysis to verify and confirm the payment history of recipients. Furthermore, HRSA introduced a shift from using whole number percentages to using dollar amounts for patient care revenue, which increased accuracy for providers.

Health Resources and Services Administration (HRSA) - Provider Relief Fund General and Targeted has established a baseline.

HHS expects the tolerable rate to remain the same due to internal controls, corrective actions and mitigations put in place, and the reduction to future outlays as the program progressed.

The program's current year improper payment and unknown payment rate of 0.06 % has been achieved with a balance of payment integrity risk and controls and represents the lowest rate that can be achieved without disproportionally increasing another risk, therefore it is the tolerable rate.

HRSA expects the tolerable rate to remain the same due to internal controls, corrective actions and mitigations put in place, and a significant reduction to future outlays with the passing of the Fiscal Responsibility Act in June 2023.

Compared to FY 2022, FY 2024 represents a substantial reduction both in terms of the improper payment rate (from 0.32% in to 0.06%) and the actual dollar amount of improper payments (from $409.48 million to $3.78 million). The percent decrease in the improper payment rate from FY 2022 to FY 2024 is based on the significant reduction of payments.
HRSA established standardized practices for calculating payments and deductions, involving pay files, systems, and verifying recipient eligibility and payment history through exploratory analysis. Additionally, as the program matured, HRSA recorded and tracked standards and guidelines throughout the program lifecycle to avoid confusion and alleviate discrepancies.

HRSA did not submit any specific budget requests for the PRF program. HRSA made payments until June 2023, when the remaining unobligated funds for provider relief payments were rescinded when the Fiscal Responsibility Act passed.