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Audit (A-07-11-03161)

Review of Nebraska's Medicaid Payments for Dual Eligible Individuals' Medicare Part A Deductibles and Coinsurance

Executive Summary

During FY 2009, the Department of Health & Human Services (State agency) did not claim Medicaid payments for Medicare Part A deductibles and coinsurance pursuant to Federal requirements and the approved State plan. The State agency did not limit payment of Medicare Part A deductibles and coinsurance to State Medicaid plan rates, resulting in 60 of the 100 claims in our sample being improperly paid. We recommended that the State agency refund $5.5 million to the Federal Government for unallowable Medicaid payments for Medicare Part A deductibles and coinsurance.

The State agency did not concur with our finding or with the two recommendations in our report. After reviewing the State agency's comments, we removed the second recommendation, but we maintain that our finding and the remaining recommendation are valid.

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