The Department of Health and Human Services (HHS) cut a little-known bureau in its ranks that was trying to recoup more than $1 billion in improper payments dispersed to providers during the COVID-19 pandemic.
The Trump administration announced the dismantling of the HHS on March 27. HHS Secretary Robert F. Kennedy Jr. told the public he would fire an additional 10,000 workers from the department in what he said would be “a painful period.”
On April 1, employees at the Provider Relief Bureau (PRB) received a reduction in force letter that explained they were out of work, a source told Fierce Healthcare. But, seemingly antithetical to the aim of President Donald Trump and government efficiency advisor Elon Musk, the PRB was actively working to recoup $1 billion for the agency.
That money seems to have been left on the table.
The 83-person PRB sits within the Health Resources and Services Administration (HRSA). As of March 31, the team was down to two full-time individuals who were responsible for notifying providers that failed to properly report the use of emergency funds meant to shore up providers during the height of the COVID-19 pandemic.
By Tuesday, April 1, “the little department that could,” as a former federal worker called it, ceased to exist.
The PRB had already been severely diminished since the start of the Trump administration. One employee took the fork-in-the-road buyout offered to all federal workers. Another employee left the bureau in January to start a new role outside of the federal government.
The PRB was stood up during the first Trump administration under the CARES Act. A HRSA webpage says the Provider Relief Fund distributed $135.2 billion to approximately 421,000 providers as of November 2024 .
The funds were distributed to hospitals in COVID-19 high-impact areas, Indian Health Service and Tribal providers, rural providers, safety net hospitals, children’s hospitals, skilled nursing facilities and to nursing home infection control.
Through post-distribution reviews of provider eligibility, the bureau identified $2.6 billion in unmerited payments. As of May 2023, it had recouped about half of the money, a report by the Government Accountability Office said.
The PRB funds allowed providers to buy personal protective equipment (PPE) and to make up for lost revenue due to the pandemic. Multiple recipients of the funds reported to the PRB that their providers had been using trash bags as PPE before they received the PRB funds.
One colleague of the dismissed worker speculated in recent days that the HRSA was pushing back on the HHS trying to cut the PRB to let them finish their work of recouping the funds. “I figured we’re bringing in money, so they’d be smart to keep us,” the worker said.
Since the distribution of funds from the PRB ended, employees have been engaged in helping providers file required reports detailing how they spent the funds. It also conducted audits of the reports and helped federal law enforcement bring down bad actors who misused the COVID-19 provider relief funds. They provided law enforcement with relevant timelines and communications with the providers and even testified in court.
“I think all of us understand what a vital role we played in helping keep the hospital open and the nursing homes open, keep healthcare providers alive,” the now-dismissed worker told Fierce Healthcare. “There are probably millions of people walking the streets right now in this country that are alive today that might have succumbed to the virus if it weren’t for the PRB.”
The bureau was always meant to be temporary, and it had plans to sunset once the improper payments were recouped, the former employee said.
This worker handled a slate of administrative tasks. The usual functions of the HHS would not be able to continue after Elon Musk’s Department of Government Efficiency slashes administrative workers, the former worker said. “We might do administrative work, but at the end of the day we’re going after a billion dollars,” the dismissed worker said.
The former employee continued: “It feels like it’s rushed … that they’re not really thinking this through and I think it’s really going to affect the product that civil servants deliver to the American people,” the employee explained.
The worker explained that they did not take the fork-in-the-road buyout offer by the federal government because they believed they were doing important work for the American public. Secondarily, they said they did not trust that the money would appear if they agreed to the buyout.
As of Tuesday, the employee is out of work. The person was just over a year away from receiving an additional retirement benefit they had been paying into since beginning work at the PRB in 2021. Because of their spouse’s inability to work, the couple no longer has healthcare insurance.
When asked whether someone else at the HHS could take up the work of the PRB, the employee said “it’s highly unlikely.” They said the learning curve for the program is steep, and everyone working on it day in and day out were no longer employed by HHS.
“It’s something that I will always be proud of, that I played a part in the Provider Relief Bureau and helping to save our healthcare system,” they concluded. “We may not have put on a gown and gloves and worked in the hospitals … but none of that could’ve happened without our hard work.”
“It just breaks my heart that they’re treating the bureau this way,” the former employee said.
The HHS did not respond to a request for comment by the time of publication.
Editor’s Note: The PRB had 83 employees, not 6, as a previous version of this article said.
