By Nebraska Department of Health and Human Services
LINCOLN, Neb. – The Nebraska Department of Health and Human Services (DHHS) today announced its full support for new guidance from the Centers for Medicare & Medicaid Services (CMS) aimed at strengthening oversight, preventing fraud and ensuring the integrity of the Medicaid program.
As part of this effort, DHHS will fully comply with CMS requests to accelerate provider revalidation activities and develop a comprehensive, long-term strategy to ensure only qualified and legitimate providers participate in Medicaid.
In its letter to states, CMS called for immediate action to develop a comprehensive plan to strengthen Medicaid provider screening and enrollment protocols, with an emphasis on strategies to enhance screening of high-risk Medicaid providers. States are expected to notify CMS of their plans for revalidation of high-risk providers within the next 10 days. CMS also directed states to submit a comprehensive two-year plan outlining enhanced oversight measures, improved data accuracy and stronger program integrity safeguards for provider screening.
These steps are part of a broader federal-state partnership designed to protect taxpayer dollars and ensure Medicaid resources are used appropriately. Under Governor Jim Pillen’s direction, DHHS has already taken significant steps to combat fraud, waste and abuse.
“Governor Pillen has made it crystal clear that fraud will not be tolerated in the State of Nebraska,” said DHHS CEO Steve Corsi. “We support CMS efforts to strengthen accountability and will move quickly and collaboratively to meet and exceed these expectations. Our goal is simple: ensure that every Medicaid dollar is spent on care for Nebraskans who truly need it.”
Provider revalidation is the process of reviewing and confirming that healthcare providers enrolled in Medicaid continue to meet all program requirements. In simple terms, revalidation can be compared to renewing a professional license. Providers must demonstrate they are properly credentialed, actively practicing and operating within program rules. This process is critical for several reasons:
Protecting Taxpayer Dollars: Revalidation helps ensure that public funds are only paid to verified providers delivering real services to real people.
Preventing Fraud: By routinely checking provider information, states can identify and remove bad actors who attempt to exploit the system. CMS has noted that fraudulent schemes cost taxpayers billions of dollars each year.
Improving Program Accuracy: Keeping provider records up to date ensures patients, health plans and the state all have reliable information about who is delivering care.
Focusing on High-Risk Areas: Enhanced reviews of higher-risk providers allow states to act quickly where fraud is most likely to occur.
DHHS will immediately begin planning for accelerated reviews of high-risk providers and will submit its detailed provider revalidation strategy to CMS within the required timeframe. The department will also continue working closely with federal partners and law enforcement to strengthen oversight and prevent fraud, waste and abuse.