NE LB381

Reduces the lookback period for Medicaid program integrity audits from four years to one year from the date of payment, after which payments cannot be adjusted except in cases of provider fraud

Requires program integrity contractors to provide clear written justification to providers before commencing an audit and deliver detailed written notification of adverse determinations including beneficiary name, dates of service, overpayment amounts, and supporting evidence

Prohibits recoupment of overpayments for at least 60 days after notice of adverse findings and until all appeals are exhausted, unless there is a credible allegation of fraud that has been verified by the department

Limits contingent fees for program integrity contractors to no more than 12.5% of amounts actually recovered (not amounts identified) and requires equal payment for identifying underpayments as for overpayments

Establishes that providers have at least 90 days to respond to documentation requests following onsite audits and at least 45 days to comply with records requests, with requests limited to 200 records per 180-day period for specific services being reviewed