Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 2 - PROVIDER PARTICIPATION
Section 471-2-006 - AUDITS
Current through September 17, 2024
All services for which claims for payment are submitted to the Department are subject to audit. During a review audit, the provider must furnish to the Department, or its authorized representative, pertinent information regarding claims for payment. If an audit reveals that incorrect payments were made or that the provider's records do not support payments that have been made, the provider shall make restitution.
006.01 SAMPLING AND EXTRAPOLATION. The Department's procedure for auditing providers may involve the use of sampling and extrapolation. The provider shall pay to the Department the entire extrapolated amount of incorrect payments calculated under this procedure after notice and opportunity for hearing.
006.02 HEARINGS. The Department must allow the provider an opportunity to rebut the Department's audit findings. If the findings are based on sampling and extrapolation, in lieu of accepting the Department's sampling and extrapolation, the provider may present an audit of 100 percent of the claims filed and services rendered during the audit period. This audit must be completed by an independent auditor with no affiliation to the provider. Any audit of this type must demonstrate that the provider's records for the unaudited services provided during the audit period were in compliance with the Department's regulations. The provider must be prepared to submit supporting documentation to demonstrate this compliance.
