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Providers urge limits on managed-care audits and clawbacks; A.G. and DHHS warn of fraud-investigation constraints
Summary
At a second hearing related to managed care, LB381 drew extensive testimony from behavioral-health clinicians who described prolonged audits, large retroactive clawbacks and appeal difficulties. The attorney generaland DHHS said a one-year lookback or other limits could impair fraud investigations and federal compliance.
More than a dozen behavioral-health clinicians and several provider groups told the Health and Human Services Committee that Nebraska Medicaid contractors have conducted prolonged and aggressive audits that leave small practices facing large clawbacks and limited appeal remedies. LB381, introduced by Sen. John Frederickson, would impose time and process guardrails on MCO audits.
Under LB381 proponents asked for written justification for audits, a 180-day completion requirement for contractors, a one-year limit on audit lookbacks except in cases of fraud, limits on the number and scope of record requests, and clearer appeals protections so contractors cannot recover…
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