Nebraska Medicaid Payments for Skilled Professional Medical Personnel

EXECUTIVE SUMMARY:

The objective of our review was to determine if the Nebraska Department of Health and Human Services, Finance and Support (State agency) properly claimed payments for skilled professional medical personnel at the enhanced Federal funding rate for fiscal year (FY) 2003. We found that the State agency did not properly claim payments for skilled professional medical personnel at the enhanced Federal funding rate for FY 2003.  Specifically, the State agency claimed costs for:  (1) personnel who did not meet the education requirements, (2) personnel in positions that did not require medical expertise, (3) directly supporting staff who did not meet supervision or job responsibility requirements, and (4) activities that did not require medical knowledge or skills.  The State agency improperly claimed operating costs at the enhanced rate and claimed some duplicate costs.

We recommended the State agency should:  (1) remit the $248,660 for duplicate claims to the Federal Government, (2) refund $292,903 to the Federal Government for costs improperly claimed at the enhanced rate, (3) work with CMS to resolve the $619,219 set aside because the State agency improperly claimed personnel costs related to claims processing, and (4) develop and implement policies and procedures for claiming skilled professional medical personnel expenditures and monitoring payments.  The State agency either agreed or partially agreed with the four recommendations.