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Wisconsin Did Not Report and Refund the Full Federal Share of Medicaid-Related Settlements and a Judgment

Wisconsin did not report and return $27.6 million (Federal share) of Medicaid-related settlements and a judgment for the period October 2008 through September 2016. Specifically, it (1) underreported $18.7 million (Federal share) for six settlements and one judgment by computing the Federal share only on the net proceeds received after fees and interest were removed and (2) failed to report any of the $9.0 million (Federal share) for two settlements.

Wisconsin did not properly report the settlements and a judgment because it (1) lacked policies that addressed the reporting of recoveries from State actions taken because of harm to its Medicaid program and (2) did not have procedures to help ensure that it reported recoveries on the Form CMS-64.

We recommended that Wisconsin (1) refund $27.6 million to the Federal Government; (2) determine whether settlements and judgments received after September 30, 2016, were reported, and refund the Federal share of any recoveries not reported in their entirety; and (3) implement policies to ensure that all settlements and judgments are reported properly. Wisconsin disagreed with our first recommendation but agreed with our other recommendations.

Filed under: Centers for Medicare and Medicaid Services