Mississippi Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

Report Materials

• Full Report(PDF, 3.1 MB)
• Report Highlights(PDF, 331.3 KB)

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.