Series: Recovery of Federal Funds Through Judgments/Settlements

Announced on 05/15/2019 | Last Modified on 09/08/2025 | Series Number: W-00-24-31522

Status

Completed

Agency

Centers for Medicare and Medicaid Services

OBJECTIVE

Any State action taken as a result of harm to a State's Medicaid program must seek to recover damages sustained by the Medicaid program as a whole, including both Federal and State shares. On October 28, 2008, CMS issued a letter (SHO #08-004) to State health officials that clarified language from Section 1903(d) of the Social Security Act, stating that the Federal Government is entitled to the Federal Medical Assistance Percentages (FMAP) proportionate share of a States entire settlement or final judgment amount. We will determine whether selected States reported and returned the applicable FMAP share of the settlement and judgment amounts to the Federal Government.

There are 3 projects in this series.

COMPLETED PROJECTS IN THIS SERIES (3)

Mississippi

Project A-06-24-04002 • Completed on September 8, 2025

State Agency Recoveries of Fraud, Waste, and Abuse in North Carolina

Project A-06-23-04004 • Completed on June 20, 2024

Audit of Medicaid Agency and MFCU Recoverable Amounts Reported by Colorado

Project A-07-19-02816 • Completed on May 14, 2024

TIMELINE

May 15, 2019

Series Number W-00-24-31522 Assigned
May 15, 2019

Project Announced
Audit of Medicaid Agency and MFCU Recoverable Amounts Reported by Colorado - A-07-19-02816
November 29, 2022

Project Announced
State Agency Recoveries of Fraud, Waste, and Abuse in North Carolina - A-06-23-04004
April 9, 2024

Project Announced
Mississippi - A-06-24-04002
May 14, 2024

Project Complete - A-07-19-02816
Audit of Medicaid Agency and MFCU Recoverable Amounts Reported by Colorado has been marked as complete. This audit resulted in 5 recommendations.
June 20, 2024

Project Complete - A-06-23-04004
State Agency Recoveries of Fraud, Waste, and Abuse in North Carolina has been marked as complete. This audit resulted in 3 recommendations.
September 8, 2025

Project Complete - A-06-24-04002
Mississippi has been marked as complete. This audit resulted in 5 recommendations.
September 8, 2025

Series Complete
Recovery of Federal Funds Through Judgments/Settlements has been marked as complete.

3 REPORT PUBLISHED

North Carolina Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases (A-06-23-04004)

24-A-06-083.01 to CMS - Open Unimplemented

Update expected on 04/02/2026

We recommend that the North Carolina Department of Health and Human Services report and return the Federal share for the seven unreported cases, totaling $30,352,630 ($20,134,402 Federal share).

24-A-06-083.02 to CMS - Open Unimplemented

Update expected on 04/02/2026

We recommend that the North Carolina Department of Health and Human Services strengthen internal controls by expanding written policies and procedures to include procedures for requesting, recording, and reporting all MFCU-determined Medicaid overpayments within prescribed regulatory timeframes, and ensuring they received all case files.

24-A-06-083.03 to CMS - Open Unimplemented

Update expected on 04/02/2026

We recommend that the North Carolina Department of Health and Human Services work with the MFCU to determine the Medicaid overpayments for cases after our audit period and ensure that all overpayments are reported on the Form CMS-64.

View in Recommendation Tracker

Mississippi Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases (A-06-24-04002)

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.

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

Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for Some Cases Identified by the State’s Program Integrity Section (A-07-19-02816)

24-A-07-075.01 to CMS - Closed Implemented

Closed on 11/17/2025

We recommend that the Colorado Department of Health Care Policy and Financing report and refund $385,180 ($673,686 Federal share) (footnote 10) in unreported Medicaid overpayments that were related to paid claims that have been recovered and collected.

24-A-07-075.02 to CMS - Open Unimplemented

Update expected on 05/17/2026

We recommend that the Colorado Department of Health Care Policy and Financing determine the value of overpayments identified after our audit period that have been recovered and collected but not reported, report them on the Form CMS-64, and refund the Federal share of the recovered overpayments.

24-A-07-075.03 to CMS - Open Unimplemented

Update expected on 05/17/2026

We recommend that the Colorado Department of Health Care Policy and Financing work with CMS to determine the amount of interest, if any, on the Federal share owed by the State agency and report that amount to the Federal Government.

24-A-07-075.04 to CMS - Closed Implemented

Closed on 10/16/2024

We recommend that the Colorado Department of Health Care Policy and Financing strengthen policies and procedures to ensure that overpayments are reported correctly and in a timely manner on the Form CMS-64 in accordance with Federal requirements.

24-A-07-075.05 to CMS - Closed Implemented

Closed on 10/16/2024

We recommend that the Colorado Department of Health Care Policy and Financing update policies and procedures to ensure that Medicaid overpayments are reported on the Form CMS-64.9C1 if recovered or on the Form CMS-64.9OFWA if not recovered within timeframes specified by Federal requirements.

View in Recommendation Tracker

Work Plan Type

Office of Audit Services

HHS Agencies

Centers for Medicare and Medicaid Services

Issue Areas

Financial Stewardship

Target Groups

Financial Groups

Medicaid

Series: Recovery of Federal Funds Through Judgments/Settlements

OBJECTIVE

COMPLETED PROJECTS IN THIS SERIES (3)

Mississippi

State Agency Recoveries of Fraud, Waste, and Abuse in North Carolina

Audit of Medicaid Agency and MFCU Recoverable Amounts Reported by Colorado

TIMELINE

3 REPORT PUBLISHED

North Carolina Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases (A-06-23-04004)

Recommendation Details (3)

Mississippi Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases (A-06-24-04002)

Recommendation Details (5)

Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for Some Cases Identified by the State’s Program Integrity Section (A-07-19-02816)

Recommendation Details (5)