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Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-07-18-02814
Report Description

This audit is one of a series of audits to determine whether States had recovered, and returned the correct Federal share of, improper Medicaid claims amounts and damages. For this audit, we focused on Nebraska’s Medicaid Fraud Control Unit (MFCU) actions related to Medicaid overpayments from legal judgments and settlements that the State had pursued under relevant Medicaid fraud statutes. Nebraska is required to report recoveries for these MFCU-determined Medicaid overpayments to the Centers for Medicare & Medicaid Services (CMS) and to refund the Federal share to the Federal Government.Our objective was to determine whether Nebraska reported and returned the correct Federal share of MFCU-determined Medicaid overpayments identified during the period October 1, 2011, through September 30, 2018.

Report Type
Audit
Location

NE,
United States

Number of Recommendations
5
Questioned Costs
$1,788,119
Funds for Better Use
$781,732

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
270783 No $1,788,119 $0

We recommend that the Nebraska Department of Health and Human Services report and refund $1,788,119 (Federal share) of the unreported MFCU-determined Medicaid overpayments that related to paid claims.

270784 No $0 $0

We recommend that the Nebraska Department of Health and Human Services report and refund up to $781,732 (Federal share) of the unreported MFCU-determined Medicaid overpayments that related to court-ordered awards if and when collected.

270785 No $0 $0

We recommend that the Nebraska Department of Health and Human Services determine the value of overpayments, including those related to court-ordered awards, identified after our audit period that have been collected but not reported; report them on the Form CMS-64; and refund the Federal share of the collected overpayments.

270786 No $0 $0

We recommend that the Nebraska Department of Health and Human Services improve policies and procedures to ensure that overpayments are reported correctly and in a timely manner on the Form CMS-64 in accordance with Federal requirements, to include adding instructions on (1) how to report double and treble damage amounts awarded by the courts, (2) application of the correct FMAP rate, and (3) the timely reporting of these overpayments.

270787 No $0 $0

We recommend that the Nebraska Department of Health and Human Services improve policies and procedures to ensure that MFCU-determined Medicaid overpayments are reported on line 2 of the Form CMS-64.9C1 if collected or on line 2 of the Form CMS-64.9OFWA if not collected within timelines specified by Federal requirements.

Department of Health & Human Services OIG

United States