Report Materials
Why OIG Did This Audit
- This audit is one of a series of audits to determine whether States had recovered, and returned the correct Federal share of, improper provider claim amounts. For this audit, we focused on Mississippi’s Medicaid Fraud Control Unit (MFCU) actions related to the recoveries of Medicaid overpayments through legal judgments and settlements that Mississippi had pursued under relevant Medicaid fraud statutes. These recoveries also include court-ordered awards. We refer to these recoveries as “MFCU-determined Medicaid overpayments.”
- This audit examined whether Mississippi reported and returned the correct Federal share of MFCU-determined Medicaid overpayments identified during Federal fiscal years 2021, 2022, and 2023.
What OIG Found
We determined that Mississippi should have reported MFCU-determined Medicaid overpayments totaling $4.5 million ($3.7 million Federal share) for the 20 cases during the period that we reviewed.
- Mississippi did not report and return MFCU-determined Medicaid overpayments related to paid claim amounts for six cases, totaling $4.2 million ($3.5 million Federal share), on the Form CMS-64;
- Mississippi did not report and return MFCU-determined Medicaid overpayments related to court-ordered awards that MFCU collected for 4 cases totaling $7,217 ($6,077 Federal share) on the Form CMS-64; and
- Mississippi reported and returned MFCU-determined Medicaid overpayments for 12 cases, totaling$290,584 ($241,948 Federal share), on the Form CMS-64.
What OIG Recommends
We made five recommendations to Mississippi, including that it return the Federal share of $3.5 million for the unreported cases that related to paid claims and $6,077 for the unreported cases that related to court-ordered awards. The full recommendations are in the report.
Mississippi did not concur with four of our findings and recommendations and partially concurred with one recommendation. For this recommendation, it detailed steps it plans to take in response to our recommendation.
25-A-06-118.01 to CMS - Open Unimplemented
Update expected on
03/07/2026
We recommend that the Mississippi Division of Medicaid 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).
25-A-06-118.02 to CMS - Open Unimplemented
Update expected on
03/07/2026
We recommend that the Mississippi Division of Medicaid 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).
25-A-06-118.03 to CMS - Open Unimplemented
Update expected on
03/07/2026
We recommend that the Mississippi Division of Medicaid work with any necessary State authorities to identify MFCU collections of 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.
25-A-06-118.04 to CMS - Open Unimplemented
Update expected on
03/07/2026
We recommend that the Mississippi Division of Medicaid 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.
25-A-06-118.05 to CMS - Open Unimplemented
Update expected on
03/07/2026
We recommend that the Mississippi Division of Medicaid 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.
View in Recommendation Tracker
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Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.