Nebraska Did Not Properly Pay Some Medicare Part B Deductibles and Coinsurance

We estimated that the Department of Health & Human Services (State agency) claimed unallowable Medicaid payments of $8.5 million ($5.6 million Federal share) during fiscal year (FY) 2009. The State agency did not always claim Medicaid payments for Medicare Part B deductibles and coinsurance for services whose payments are limited to the State Medicaid plan rate in accordance with Federal requirements and the approved State plan. Specifically, for 68 of the 100 claims in our sample, the State agency did not limit payment of Medicare Part B deductibles and coinsurance to State Medicaid plan rates as required under the State plan.

These discrepancies occurred because the State agency did not compare the Medicare payment to the State Medicaid plan rate. The State agency did not make this comparison because it did not have policies and procedures requiring it to do so.

We recommended that the State agency refund $5.6 million to the Federal Government for unallowable Medicaid payments for Medicare Part B deductibles and coinsurance. The State agency did not concur with our finding or with the two recommendations in our draft 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.