The American Medical Association (AMA) and other prominent medical groups are urging the Biden administration to give providers more time to report on COVID-19 pandemic assistance before the government takes back some of the funding.

The Department of Health and Human Services (HHS) is clawing back as much as $100 million in pandemic assistance from healthcare providers who didn’t comply with the agency’s reporting requirements, Bloomberg Law first reported late last week.

The Provider Relief Fund (PRF), supported by the Health Resources and Services Administration (HRSA), provides up to $178 billion in relief funds for healthcare providers that lost revenue and expenses due to the COVID-19 pandemic. The relief was authorized as a part of the bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act.  HSRA distributed $42.8 billion in the first phase, which began April 10, 2020.

HRSA allocated roughly $30 billion to providers based on the provider’s Medicare fee-for-service payments in 2018 and allocated an additional $20 billion to these providers based on annual gross receipts in the most recent tax year available. 

PRF funds are grants and do not have to be repaid, according to HRSA in a FAQ document (PDF). But providers must attest to receiving these funds and comply with the applicable terms and conditions of the PRF.

Providers who received more than $10,000 in COVID relief dollars from HRSA between April 10, 2020, and June 30, 2020, were required to report how the funds were spent by the end of September 2021. The agency pushed the initial deadline by 60 days and also granted providers a 60-day grace period to come into compliance before beginning enforcement.

In early March, HRSA sent notices to noncompliant facilities, giving them 30 days to repay the funds.

“If you do not return the funds, HRSA will initiate the recovery of all funds not reported on” during the first reporting period, the agency said in a March 10 letter viewed by Fierce Healthcare.

Those providers also will be ineligible for future relief payments, HRSA said in the letter.

Many practices were unaware of the reporting deadline and providers need more time to comply, according to the AMA, the Medical Group Management Association (MGMA) and 30 other national medical specialty groups in a letter (PDF) to HRSA Administrator Carole Johnson.

These groups are asking HRSA to reopen the reporting period for the phase one funding for at least 60 days to enable more practices to comply.

"Small and rural physician practices appear to be particularly impacted by the reporting deadline and the potential recoupment of funds. These practices, often under-resourced even while they provide critical health care services, cannot afford to have the funds they received recouped," the groups wrote in the letter.

During the late fall when the delta variant was surging, many physician practices were greatly impacted by the COVID-19 surges in ways that may have prevented or delayed the required reporting, the groups said.

"From speaking with our members, there seem to be a variety of things at play and reasons why they may have missed reporting—ranging from staff turnover, changes and upgrades to office technology and infrastructure, and communications from HRSA that went to ‘spam’ folders and went unread until much later," Claire Ernst, MGMA’s director of government affairs, told Fierce Healthcare.

Many practices reported they were not contacted about the requirement to report and were thus unaware of the deadline. At the same time, staffing challenges and turnover resulted in the practice’s point of contact no longer being affiliated with the practice, the groups wrote in the letter.

"We are hopeful that HRSA will heed our call to reopen the reporting portal for these practices and also encourage HRSA to ensure they are targeting and communicating with recipients that did not receive communication the first time. We also would encourage, at the very least, that HRSA establish a transparent and straight-forward appeals process for those who missed the deadline," Ernst said.

"As we are very connected to our members, we would like to work with HRSA on best ways to identify and reach the remaining practices that have not reported to bring them into compliance," the groups wrote in the letter. "We stand ready to work together with HRSA on getting physician practices to report on Provider Relief Funding so they can retain the PRF funds they so desperately needed to stay afloat during the COVID-19 pandemic." 

The clawback comes as providers are still facing financial hardships from the impact of the COVID-19 pandemic. Hospital and medical groups are also pushing lawmakers to avoid Medicare reimbursement cuts.

At the same time, the White House has warned that it needs more funding for pandemic relief and that providers will not get reimbursed for testing, treating and vaccinating the uninsured for COVID-19 unless Congress acts soon.

HHS Secretary Xavier Becerra told a House appropriations panel Thursday that it was vital to approve additional relief funding, especially to help providers. He said that after giving providers notice of the March 22 deadline for uninsured claims, the agency saw 2 million claims over eight days. Becerra is expecting a similar deluge of claims to occur before the April 5 deadline for providers to get reimbursed for COVID-19 vaccine administration uninsured claims.

Last week, the Senate reached a bipartisan “agreement in principle” for a $10 billion COVID-19 relief bill, but the deal does not include dedicated funding to restart reimbursements to providers for uninsured care.

Two weeks ago, HHS announced the release of another $413 million in PRF payments, bringing the department to nearly $12 billion in funds distributed through the COVID-19 support program since November 2021.

The new payments will reach over 3,600 providers across the country, according to HHS, and is the fourth round of funds released under the program’s $17 billion fourth tranche. Roughly $5 billion in funds from that pool remain to be distributed.