On November 2, 2026, the HHS Office of Inspector General posted Audit A-09-23-01006, issued October 29, 2026. The report concludes that HRSA made $658 million in potential overpayments to selected providers under Phase 3 of the Provider Relief Fund. OIG recommends that HRSA review the sampled providers, determine the amount overpaid, and seek repayment. HRSA has said it will do so, pending available resources.
The Provider Relief Fund was the largest direct federal cash program for health care providers in history. Congress appropriated $178 billion. HRSA distributed $145.9 billion. Phase 3 alone sent about $19.3 billion to 64,048 providers between November 2020 and March 2023. Each of those providers submitted an application through HRSA’s Application and Attestation Portal, entered revenue and expense figures, and accepted Terms and Conditions that made those figures a condition of payment.
The audit arrives while pandemic-era relief remains an enforcement priority across the government. DOJ’s Civil Division continues to resolve Paycheck Protection Program and EIDL matters under the False Claims Act years after the loans were made. The Department’s 2026 benefits fraud directives fast-track qui tam review and route civil matters to criminal and administrative channels. The Fiscal Responsibility Act of 2023 rescinded unobligated PRF funds, which means HRSA can no longer true up an overpayment against a later distribution. HRSA’s only remaining option is to demand the money back.
The Paycheck Protection Program showed how an inspector general audit becomes a repayment demand and then a False Claims Act case. Audit findings lead to agency recoupment. Recoupment files lead to referrals. Referrals and public payment data lead to qui tam complaints. This post covers what the audit found, who is exposed and on what theories, and the defenses available.
Every sampled provider was eligible; OIG’s findings concern the amounts paid, not the right to be paid. Recoupment requires no proof of intent. The False Claims Act does. A provider’s exposure depends on which of those two standards the government can meet.
What OIG Found: $658 Million Across 45 Providers
OIG audited $19 billion in Phase 3 payments made to 50,168 providers that received $10,000 or more between November 16, 2020 and March 1, 2023. It drew a stratified random sample of 150 providers representing $5.2 billion in payments, plus a nonstatistical sample of 15 providers representing $9 million. The nonstatistical sample consisted of Planned Parenthood affiliates reviewed at the request of members of Congress. OIG found no false or misleading information in those applications.
Every sampled provider met the eligibility requirements. None was excluded or terminated, and each had a valid TIN. For 65 of the 150 statistical-sample providers, the payment was miscalculated or unsupported. Seven of the 15 nonstatistical providers were miscalculated.
| Finding | Providers (statistical sample) | Potential overpayment |
|---|---|---|
| Prior payments to subsidiaries not deducted | 1 | $2.6 million |
| Incorrect figures entered on the application | 2 | $303.7 million |
| Nonpatient care revenue or expenses included | 20 overpaid, 19 underpaid | $158.2 million |
| Wrong loss ratio applied | 7 overpaid, 7 underpaid | $36.1 million |
| No tax return or financial statements supporting revenue | 9 | $155.0 million |
| Total potential overpayments | 39, plus 6 in the nonstatistical sample | $657.9 million |
Source: OIG Audit A-09-23-01006, pp. 9-17. OIG also found $131.3 million in potential underpayments to 26 providers. It declined to extrapolate to the full population because the lower confidence bound fell below the known sample overpayments.
The Two Largest Overpayments Were Data-Entry Errors
Two acute-care hospitals account for $303.7 million of the total. In the first, a quarterly patient care revenue figure of $755,497,000 was processed as $755,497. HRSA’s contractor caught and corrected the second-quarter figure but not the first. The result was a $166 million potential overpayment. In the second, the contractor flagged a typo and adjusted the figure to $888,417,812, but HRSA calculated the payment on $88,417,812. That produced a $137.6 million potential overpayment. OIG attributes both to HRSA’s contractor and to HRSA’s failure to use the corrected figures.
Nonpatient Care Revenue and Expenses
This finding affected the most providers and applies to the widest range of Phase 3 recipients. HRSA’s application instructions defined patient care revenue as amounts received for health care services delivered directly to patients. Non-340B pharmacy revenue, capitation, third-party activity, grants, tuition, bad debt, and contractual adjustments were to be excluded. On the expense side, donations, advertising, gifts, travel, entertainment, and alcohol were not patient care expenses.
OIG found 39 statistical-sample providers and 4 nonstatistical providers whose figures included those items. One acute-care hospital reported $2.1 billion in patient care revenue. OIG recalculated it at $1.94 billion after removing non-340B pharmacy, third-party, and capitation revenue, and identified $14.2 million in potential overpayment. A multispecialty practice included donations, advertising, gifts, travel, and alcoholic beverages in its patient care expenses, producing a $1.7 million potential overpayment.
HRSA did not require documentation for the self-reported percentage of revenue from patient care. It assumed any revenue or expense it could not classify was patient care related. OIG rejected that approach.
Unsupported Revenue
Nine providers were paid on revenue figures with no supporting tax return or financial statement. One S corporation submitted an individual Form 1040 instead of a Form 1120-S. A new 2020 home health provider submitted a partnership return and quarterly employment tax returns, none of which supported the patient care revenue it claimed. HRSA’s own rule was that no payment should issue without support. OIG found $155 million in potential overpayments on this ground alone.
Why It Happened
HRSA received more than 100,000 Phase 3 applications. It used self-reported figures to calculate payments without reviewing supporting documentation for roughly 95 percent of them. Only 5 percent went through manual review, though those covered about 73 percent of the dollars. OIG found that even the manual reviews failed to catch errors. HRSA’s response did not concur or nonconcur. It disputed one calculation and ten rounding differences, noted that two providers had already returned a combined $324 million, and stated that it will review the remaining 46 sampled providers and seek repayment, pending available resources.
How Phase 3 Worked and What Providers Certified
Phase 3 opened in November 2020 for new providers, behavioral health providers, and providers that had already received General Distribution payments. HRSA paid the greater of two figures: 2 percent of the provider’s annual patient care revenue, or 88 percent of its net revenue losses for the first half of 2020. Prior PRF payments to the provider and its listed subsidiaries were subtracted at the end.
The entire calculation ran on five fields the provider typed into the portal: gross revenue, percentage of revenue from patient care, operating revenues from patient care, operating expenses from patient care, and provider type. The provider also listed its own TIN and any subsidiary TINs. Documentation was required for gross revenue and the quarterly figures. It was not required for the percentage of revenue from patient care, and that percentage drove the whole payment.
Every recipient accepted the Phase 3 Terms and Conditions, either by attesting in the portal or by keeping the money for 90 days. Four certifications in that document matter in any enforcement action.
Those four terms supply the materiality language, the knowledge warning, the recoupment authority, and the audit cooperation duty. The government will cite the third term as the provider’s own concession that compliance was material.
Who Faces Liability, For What, and How
The audit names no provider. It describes 45 providers by type and dollar amount, and HRSA knows who they are. The exposure comes in three forms, and a provider can face all three at once.
Track One: HRSA Recoupment
HRSA has stated it will review the sampled providers and seek repayment. HRSA’s repayment and debt collection process for audit-related findings starts with a Management Decision Letter stating the amount and the reason. The provider gets one opportunity to request a Decision Review, measured from the date the letter was sent, not received. HRSA may uphold or reduce the finding. It has no authority to waive a debt.
A provider that neither repays nor requests review is referred to the HHS Program Support Center, which can service the debt or send it to Treasury’s Centralized Receivables Service. Treasury issues a 30-day demand. After 90 days the debt moves to Treasury Cross-Servicing, which can offset federal payments owed to the provider, including Medicare and Medicaid receivables, refer the debt to a private collection agency, and refer it to DOJ for litigation. Collection fees are added. Once a debt is referred, HRSA and PSC stop communicating with the provider, and the provider loses the chance to dispute the findings.
Recoupment requires no proof of intent. The Terms and Conditions make noncompliance with any term grounds to recoup. A hospital whose figure was mistyped by HRSA’s own contractor faces the same recoupment demand as a practice that padded its expenses with alcohol and gifts. The difference between those two providers matters under the False Claims Act.
Track Two: The False Claims Act
A Phase 3 application was a claim for payment from the federal government. The certification that the figures were true, accurate, and complete was a statement material to that claim. If the figures were false and the provider acted knowingly, the elements of 31 U.S.C. § 3729(a)(1)(A) and (B) are met. Knowingly includes deliberate ignorance and reckless disregard. No specific intent to defraud is required.
The audit also supports reverse false claims under § 3729(a)(1)(G). A provider that learns it was overpaid and knowingly keeps the money, or knowingly avoids the obligation to return it, is liable for retaining an overpayment. The 60-day repayment rule for Medicare overpayments does not govern PRF, but the Terms and Conditions impose a record-keeping and reporting duty, and HRSA’s returning-funds process has been open since 2021. A relator will look for an audit finding that the provider received and did not act on.
FCA exposure is treble damages plus a per-claim penalty that, for violations assessed after July 3, 2025, runs from $14,308 to $28,619. On a $14 million overpayment, treble damages alone exceed $42 million. The statute of limitations under 31 U.S.C. § 3731(b) runs six years from the violation or three years from when the government knew or should have known, up to ten years. A Phase 3 payment made in December 2020 remains actionable until at least December 2026 on the six-year clock and potentially until 2030 on the discovery rule. The government will argue that the discovery clock did not start until OIG completed its fieldwork in 2026.
DOJ is already resolving PRF cases on the lost-revenue theory. On October 27, 2026, six dialysis centers owned by Sankar Nephrology Group agreed to pay about $2 million to the U.S. Attorney’s Office for the District of Massachusetts. The settlement alleged that the centers reported zero revenue to HRSA after they had closed or been sold, creating the false impression that the pandemic had wiped out their revenue. The government’s theory was that the reports were false claims and false statements material to a false claim. The audit’s nonpatient care revenue and loss ratio findings describe the same category of conduct at a larger scale.
Track Three: Criminal Exposure
The Terms and Conditions warned that deliberate omission, misrepresentation, or falsification could be punished by imprisonment. The statutes are 18 U.S.C. § 1001 for false statements to a federal agency, 18 U.S.C. § 1343 for wire fraud, and 18 U.S.C. § 1347 for health care fraud, which covers schemes to obtain money from any health care benefit program. The ten-year limitations periods Congress enacted for PPP and EIDL fraud do not reach PRF. Each of these statutes carries a five-year limit. For an application submitted in late 2020, that window has closed unless a later act restarts it. Later acts are common: the attestation in the portal, the post-payment reports filed between 2021 and 2023, a Decision Review submission, and any response to an HRSA or OIG document request are each separate statements. Payments made through March 2023 remain within the criminal window into 2028.
Criminal exposure is reserved for cases where intent is provable: a provider that reported zero revenue after selling the business, a provider that invented quarterly figures, or a provider that submitted a tax return belonging to a different entity. The audit does not describe conduct of that kind; the Boston dialysis settlement is an example of it.
The PPP Playbook, Applied to PRF
The Paycheck Protection Program is the precedent. PPP relied on borrower self-certification, paid quickly, and was audited afterward. The SBA Office of Inspector General estimated that roughly $200 billion in PPP and EIDL funds went to potentially fraudulent actors. Loan data was public, and relators mined it. DOJ’s Civil Division built a pandemic fraud docket on the resulting qui tam complaints and in fiscal year 2025 obtained more than 200 pandemic-related FCA settlements and judgments.
The Provider Relief Fund has the same features. HRSA paid on self-reported figures without reviewing documentation for 95 percent of Phase 3 applications. Every attested payment is posted in the HHS Provider Relief Fund public use file, with provider name, state, and amount. A relator can match that file against a provider’s Medicare cost reports, IRS Form 990, or audited financial statements and estimate whether the payment exceeds 2 percent of patient care revenue. The Terms and Conditions told every recipient that public disclosure would allow third parties to estimate its gross receipts.
This audit is one in a series. OIG describes it as one of several audits examining HRSA’s oversight of payment calculations and provider eligibility, and providers’ compliance with reporting and use requirements. Phase 1 payments were covered in a separate audit. This report tests the application figures themselves against the supporting documents, and a relator can run the same test. The Boston dialysis settlement, announced five days before the report posted, shows the enforcement side.
Where the Defense Begins
An overpayment is not a false claim. Each of the defenses below rests on that distinction.
The Government Made the Error
The two largest findings, $303.7 million, were HRSA contractor mistakes. In both cases the provider’s documentation showed the correct figure. The contractor either failed to apply its own correction or HRSA ignored it. A provider that submitted accurate support and received a payment it did not calculate has made no false statement. The only FCA theory left is reverse false claims, which requires proof that the provider knew it had been overpaid and knowingly avoided repayment. The government carries that burden.
OIG’s Recalculation Is Not HRSA’s Policy
OIG calls the amounts potential overpayments, and the qualifier is accurate. HRSA told OIG that miscellaneous income, research income, gifts, entertainment, and travel required an audit to classify. OIG classified them as nonpatient care on its own authority. HRSA’s own practice was to treat anything it could not classify as patient care related and to accept figures within a margin of error. HRSA’s response disputed one calculation and ten rounding differences and did not concur with the findings. A provider in Decision Review can hold HRSA to the rules HRSA applied in 2020 and 2021, not the rules OIG applied in 2026.
Knowledge Is Measured at the Time of the Application
Under United States ex rel. Schutte v. SuperValu Inc., the FCA’s scienter element turns on what the defendant actually believed when it submitted the claim, not on what a court later decides the rules meant. HRSA’s PRF FAQs were revised repeatedly during the Phase 3 window. HRSA removed its lost-revenue definition from the application instructions in August 2020, three months before Phase 3 opened. The audit itself notes that HRSA substantially revised its PRF websites in March 2026. A provider that classified retail pharmacy revenue, capitation, or bad debt in good faith under the guidance available at the time has a knowledge defense that survives an OIG recalculation.
Materiality and Government Knowledge
The Terms and Conditions concede materiality in general terms. They do not establish that a particular line-item classification was material to a payment within HRSA’s margin of error. Where HRSA’s contractor manually reviewed an application, saw the figures, and paid anyway, the government’s own conduct is evidence that the item was not material under Universal Health Services v. United States ex rel. Escobar. Seventy-three percent of Phase 3 dollars went through manual review.
Underpayments and Netting
OIG found $131.3 million in underpayments to 26 providers in the same sample. Some providers were overpaid on one finding and underpaid on another. OIG’s own footnote acknowledges that HRSA could have netted over- and underpayments across distributions had Congress not rescinded the funds. A provider facing a recoupment demand on one line item is entitled to credit for every line item that cut the other way.
Documentation
The Terms and Conditions required records under 45 C.F.R. §§ 75.302 and 75.361 through 75.365. The nine unsupported-revenue findings turned on the wrong form being uploaded, not on the revenue being fictitious. An S corporation that uploaded a Form 1040 instead of a Form 1120-S can produce the Form 1120-S. The question in Decision Review is whether the revenue was real and supportable. Which form was uploaded in November 2020 is a documentation gap the provider can close.
The Self-Disclosure Pilot
On October 22, 2026, DOJ’s Civil Division and HHS opened a six-month Healthcare False Claims Act Self-Disclosure Pilot Program. A company that discloses potential civil FCA violations not already known to the government, produces the documents, describes its remediation, and repays at a multiplier of 1.25 to 1.6 receives a DOJ release, no exclusion, no Corporate Integrity Agreement, no CMS revocation, and no civil monetary penalties. Submissions close April 22, 2027. The 45 sampled providers are likely outside the program because their conduct is known. The other 50,000 Phase 3 recipients whose figures were built the same way are not. For a provider that finds nonpatient care revenue in its Phase 3 application, the pilot converts treble damages plus penalties into a 1.25x to 1.6x repayment with a release.
Parallel Proceedings
Everything a provider says in Decision Review, in a response to an HRSA document request, or in a response to a civil investigative demand can be used in a later FCA case or criminal investigation. The Terms and Conditions required cooperation with audits by OIG and the Pandemic Response Accountability Committee. Cooperating with an audit does not require volunteering a narrative. The recoupment response should be prepared with a possible False Claims Act case in view from the first letter.
An overpayment is not a false claim. Recoupment asks whether the formula was applied correctly. The False Claims Act asks what the provider knew when it submitted the figures.
Former DOJ Prosecutors Who Built These Cases
Armstrong & Bradylyons PLLC represents executives, providers, medical professionals, owners, and entities in complex health care cases, both civilly and criminally. That includes Provider Relief Fund recoupment proceedings, False Claims Act investigations and qui tam litigation, and the parallel criminal matters that follow pandemic relief audits.
Scott Armstrong served as an Assistant Chief at DOJ’s Fraud Section and as a leading trial attorney in its Healthcare Fraud Unit. He co-led the investigation and charges in one of the first COVID-era PPP fraud cases, involving over $7 million, and was lead counsel in health care fraud cases totaling over $600 million in false claims to federal programs. He has tried sixteen federal jury trials, including nine health care fraud trials.
Drew Bradylyons served as an Assistant Chief supervising the Healthcare Fraud Unit’s South Florida Strike Force and as Chief of the Financial Crimes and Public Corruption Unit at the U.S. Attorney’s Office for the Eastern District of Virginia. In that role he supervised parallel civil, criminal, and administrative fraud proceedings involving more than $1 billion in claims, including government program fraud matters where an agency audit, a civil investigative demand, and a grand jury subpoena were all live at once.
The firm’s attorneys tried 17 federal jury trials in health care fraud cases at DOJ’s Fraud Section involving over $2.8 billion in alleged false and fraudulent claims to federal health care programs, and 25 federal jury trials in complex fraud matters overall. Chambers and Partners recognized the firm in its USA Spotlight 2027 guide as a Leading Firm in Litigation: White-Collar Crime & Government Investigations for the DC Metro market.
That work runs through the firm’s health care fraud defense and False Claims Act defense practices. The firm is based in Washington, D.C. and handles matters in every federal district.
Frequently Asked Questions
What did the HHS-OIG audit find about Provider Relief Fund Phase 3 overpayments?
HHS-OIG Audit A-09-23-01006, posted November 2, 2026, found that HRSA made $657.9 million in potential overpayments to 45 providers under Phase 3 of the Provider Relief Fund. OIG reviewed a stratified random sample of 150 providers that received $5.2 billion and a nonstatistical sample of 15. All 165 were eligible. But 65 of the 150 were paid amounts that were miscalculated or unsupported.
The causes were nonpatient care revenue and expenses included in the application figures ($158.2 million), revenue with no supporting tax return or financial statements ($155 million), the wrong loss ratio ($36.1 million), two data-entry errors by HRSA’s contractor ($303.7 million), and prior payments to subsidiaries not deducted ($2.6 million). OIG also found $131.3 million in underpayments to 26 providers. It recommended that HRSA review the sampled providers and seek repayment of up to $657.9 million. HRSA stated it will do so, pending available resources.
Does an HHS-OIG finding of a Provider Relief Fund overpayment mean the provider committed fraud?
No. An overpayment finding means OIG recalculated the Phase 3 formula and reached a lower number than HRSA paid. It is not a finding of intent. Every provider in the audit met the eligibility requirements, and the two largest overpayments were caused by HRSA’s own contractor entering the wrong figures. The audit itself describes the amounts as potential overpayments, and HRSA disputed several of OIG’s calculations.
Recoupment under the Terms and Conditions requires no proof of intent. Fraud liability under the False Claims Act or the criminal statutes requires proof that the provider knowingly submitted false figures or knowingly kept money it knew it was not entitled to. The audit establishes the first but not the second.
What is an HRSA Management Decision Letter and how does Provider Relief Fund Decision Review work?
A Management Decision Letter is the notice HRSA sends after an audit or assessment. It states the findings, the repayment amount, and the Repayment ID. A provider that disagrees has 60 days from the date of the letter, not the date of receipt, to submit a Decision Review Request through HRSA’s Decision Review Portal. The request must include all supporting documentation at the time of submission; nothing can be added afterward.
HRSA may uphold or reduce the finding. The provider may pay the debt while the request is pending, and HRSA refunds any amount it does not sustain. HRSA’s decision is final and is issued as a Final Determination Letter. A provider that neither pays nor requests review within 60 days is referred to the HHS Program Support Center for debt collection, with interest and penalties as stated in the letter.
What happens if a provider does not repay a Provider Relief Fund overpayment?
The debt is referred to the HHS Program Support Center, which can service it or refer it to Treasury’s Centralized Receivables Service. Treasury issues a 30-day written demand. If the debt is not paid within 90 days, it moves to Treasury Cross-Servicing. Cross-Servicing can offset federal payments owed to the provider, including Medicare and Medicaid receivables and tax refunds, refer the debt to a private collection agency, and refer it to the Department of Justice for litigation. Collection fees are added.
Once a debt is referred, HRSA and the Program Support Center stop communicating with the provider, the findings can no longer be disputed, and HRSA has no authority to waive the debt. The referral file is also available to OIG and DOJ as a potential False Claims Act lead.
Can a Provider Relief Fund overpayment lead to False Claims Act liability?
Yes, if the provider acted knowingly. A Phase 3 application was a claim for payment, and the recipient certified that its figures were true, accurate, and complete. If the figures included nonpatient care revenue, omitted subsidiary TINs, or were unsupported, and the provider knew that or recklessly disregarded it, liability under 31 U.S.C. 3729(a)(1)(A) and (B) attaches. A provider that learns of an overpayment and knowingly keeps it faces reverse false claims liability under 3729(a)(1)(G).
Exposure is treble damages plus a penalty of $14,308 to $28,619 per claim for violations assessed after July 3, 2025. Where the overpayment resulted from HRSA’s own calculation error and the provider’s documentation was accurate, the only available theory is knowing retention. On October 27, 2026, DOJ resolved a Provider Relief Fund False Claims Act case against six dialysis centers for about $2 million on the theory that they reported zero revenue after closing or selling the business.
What is a reverse false claim in the Provider Relief Fund context?
Under 31 U.S.C. 3729(a)(1)(G), a person who knowingly conceals or knowingly and improperly avoids an obligation to pay money to the government is liable under the False Claims Act. The statute defines obligation to include the retention of an overpayment. In the Provider Relief Fund context, the theory applies when a provider learns that its payment exceeded what the Phase 3 formula allowed and does not return the excess.
The knowledge element is the same as for an affirmative false claim. A provider that did not know of the overpayment, or that reasonably believed its payment was correct under the guidance available at the time, has a defense. An OIG audit finding or a Management Decision Letter is the kind of notice a relator or DOJ will point to as the moment knowledge began. HRSA’s Returning Funds process has been open since 2021.
Can a whistleblower file a qui tam lawsuit over a Provider Relief Fund payment?
Yes. The False Claims Act allows a private person to file a sealed complaint on behalf of the United States and share in the recovery. Every Provider Relief Fund payment to a provider that attested to the Terms and Conditions is published in the HHS Provider Relief Fund public use file with the provider’s name, state, and amount.
A relator can compare that payment to a provider’s Medicare cost report, IRS Form 990, or audited financial statements and estimate whether the payment exceeds 2 percent of patient care revenue or implies an unusual loss ratio. Former employees, controllers, and billing consultants who saw how the application figures were built are the other source. The same approach produced the Paycheck Protection Program qui tam docket, and the OIG audit now tells relators which categories of error to look for.
What is the statute of limitations for Provider Relief Fund False Claims Act cases?
Under 31 U.S.C. 3731(b), a civil False Claims Act action must be filed within six years of the violation, or within three years of when the responsible government official knew or should have known the material facts, whichever is later, subject to a ten-year outer limit. Phase 3 payments were made from November 2020 through March 2023, so the six-year period runs into 2029 for the latest payments, and the discovery rule can extend it to 2030 or later.
The ten-year periods Congress enacted for PPP and EIDL fraud do not apply to the Provider Relief Fund. Criminal statutes such as 18 U.S.C. 1001 and 1343 carry five-year limits, but each later attestation, post-payment report, Decision Review submission, or response to a document request is a separate statement that can start a new period.
What counts as patient care revenue under the Provider Relief Fund?
HRSA’s Phase 3 application instructions defined operating revenue from patient care as amounts received for health care services delivered directly to patients, including pharmacy revenue earned through the 340B Drug Pricing Program. Excluded items included retail pharmacy revenue outside 340B, capitation, third-party activity revenue, grants, tuition, insurance proceeds, investment and real estate income, fundraising, interest income, bad debt, contractual adjustments, and charity care adjustments. HRSA’s policies also excluded nonpatient care dining, parking, education, and administrative service fees.
On the expense side, donations, grant expenses, advertising, gifts, entertainment, travel, and alcohol were not patient care expenses. The audit treated miscellaneous and research income as potentially nonpatient care, a classification HRSA said required an audit to resolve. Whether a provider’s classification was correct, and what the provider understood the rule to be in 2020, are separate questions.
Are executives, owners, and CFOs personally liable for a false Provider Relief Fund application?
They can be. The False Claims Act reaches any person who presents, or causes to be presented, a false claim, and the Phase 3 attestation was made by an individual who certified that he or she was authorized to act for the provider. A chief financial officer who assembled the quarterly figures, an owner who approved the application, or an outside consultant who prepared it can be named alongside the entity. DOJ’s pandemic relief settlements regularly name owners and executives with their companies.
On the criminal side, 18 U.S.C. 1001 and 1343 apply to the individual who made the statement. Individual liability still requires proof of individual knowledge: what that person saw, reviewed, and understood when the figures were entered.
Does the DOJ-HHS self-disclosure pilot program apply to Provider Relief Fund overpayments?
The Healthcare False Claims Act Self-Disclosure Pilot Program announced October 22, 2026 covers potential civil False Claims Act violations involving federal health care programs that are not already known to the government. A provider must disclose all relevant details, produce documents showing the full nature of the conduct, describe its remediation, and repay at a multiplier of 1.25 to 1.6 set by timeliness, duration, scope, leadership involvement, and financial benefit.
In return, DOJ provides a release for the disclosed conduct, HHS-OIG forgoes exclusion and a Corporate Integrity Agreement, CMS does not revoke enrollment, and no civil monetary penalties are imposed. Submissions close April 22, 2027. Providers already identified in the OIG audit are likely ineligible because the conduct is known. Providers outside the sample whose Phase 3 figures contain the same errors may qualify, and the multiplier compares favorably to treble damages plus per-claim penalties.
What experience do Scott Armstrong and Drew Bradylyons bring to Provider Relief Fund and pandemic relief fraud matters?
Scott Armstrong served as an Assistant Chief at DOJ’s Fraud Section and co-led the investigation and charges in one of the first COVID-era PPP fraud cases, involving over $7 million. He was lead counsel in health care fraud cases totaling over $600 million in false claims and has tried sixteen federal jury trials, including nine health care fraud trials.
Drew Bradylyons supervised the Healthcare Fraud Unit’s South Florida Strike Force as an Assistant Chief and later served as Chief of the Financial Crimes and Public Corruption Unit in the Eastern District of Virginia, where he supervised parallel civil, criminal, and administrative government program fraud proceedings involving more than $1 billion in claims. The firm’s attorneys have over 25 years of combined DOJ experience and 25 federal jury trials, including 17 health care fraud trials involving over $2.8 billion in alleged false and fraudulent claims to federal health care programs. Chambers and Partners recognized the firm in its USA Spotlight 2027 guide as a Leading Firm in Litigation: White-Collar Crime & Government Investigations for the DC Metro market. The firm represents executives, providers, medical professionals, owners, and entities in complex health care cases, both civilly and criminally.
Where does Armstrong & Bradylyons PLLC defend Provider Relief Fund recoupment and False Claims Act matters?
Armstrong & Bradylyons PLLC is based in Washington, D.C., home to DOJ’s Civil Division Fraud Section, HRSA’s Provider Relief Bureau, and HHS-OIG headquarters. The firm defends providers in HRSA Decision Review, Treasury debt collection, civil investigative demands, qui tam litigation, and parallel criminal investigations in every federal district.
The firm’s reach is national. Its attorneys tried cases and ran investigations in federal courts across the country during a combined 25-year DOJ career, and the firm appears wherever HRSA, HHS-OIG, or DOJ pursues a Provider Relief Fund matter. That includes the District of Columbia, where the Civil Division’s Fraud Section sets False Claims Act policy and HRSA’s Provider Relief Bureau sits; the District of Maryland, which handles substantial health care and pandemic relief fraud matters tied to the federal programs headquartered in the region; the Eastern District of Virginia, where Drew Bradylyons led the Financial Crimes and Public Corruption Unit; the Southern District of Florida and Southern District of Texas, home to DOJ Strike Force dockets both partners worked; and the District of Massachusetts, where DOJ resolved its most recent PRF False Claims Act settlement. A Phase 3 recipient in any of the 50,168 provider TINs OIG sampled from can be reached by the same audit, and the firm defends them in every federal district.
Facing a Provider Relief Fund Repayment Demand or False Claims Act Investigation?
Armstrong & Bradylyons PLLC represents executives, providers, medical professionals, owners, and entities in complex health care cases, both civilly and criminally, including HRSA recoupment proceedings, civil investigative demands, qui tam litigation, and parallel criminal investigations nationwide. As former DOJ Fraud Section prosecutors, Scott Armstrong and Drew Bradylyons built and supervised the pandemic relief and health care fraud cases the government brings today.
