Mississippi Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

Overpayments not reported related to court-ordered awards that MFCU collected for four cases totaling $7,217 ($6,077 Federal share).

The State agency did not report and return the Federal share of all MFCU-determined Medicaid overpayments identified for FYs 2021 through 2023. It reported and returned $290,584 ($241,948 Federal share) for 12 cases, compared with $4,461,240 ($3,743,043 Federal share) for 20 cases identified during the audit period.

Overpayments not reported related to paid claim amounts for six cases totaling $4,163,439 ($3,495,018 Federal share).

Court-ordered awards that the MFCU may have collected for nine cases totaling $138,588 ($114,483 Federal share) may not have been correctly reported and returned.

The underreporting occurred because the State agency was not aware that it had to report overpayments for cases in which it had not yet collected the payments; believed that since the MFCU receives all court-ordered awards and those amounts do not go to the State agency, it did not have to report the awards; did not have adequate internal controls to ensure that all checks received were reported; and did not think it had to return the Federal share for incarcerated providers.

Work with CMS to determine whether any Federal share is owed for the six unreported cases that related to paid claims, totaling $4,163,439 ($3,495,018 Federal share).

Work with any necessary State authorities to report and return the Federal share of the unreported MFCU-determined Medicaid overpayments that related to court-ordered awards that were collected, totaling $7,217 ($6,077 Federal share).

Work with any necessary State authorities to identify the remaining $138,588 ($114,483 Federal share) in court-ordered awards and report and return the Federal share if and when they are collected.

Strengthen internal controls by expanding written policies and procedures to include procedures for reviewing all checks and MFCU-determined Medicaid overpayment court documents received from the MFCU, recording them in the State agency’s accounting system, reporting them on the Form CMS-64 within prescribed regulatory timeframes, and adding instructions on how to report court-ordered awards.

Work with any necessary State authorities to determine the Medicaid overpayments and court-ordered awards for cases after our audit period and include any unreported items on the Form CMS-64 according to Federal requirements.