In most of the cases, HHS was able to find money within its existing budget to make the repayments.

Phillips said the department could be liable for millions more than the $57 million that has already been paid, depending on the outcome of discussions with federal agencies. The state is disputing some of those penalties. In other cases, the federal agencies have not determined a final total.

The state knows of about $45 million worth of potential penalties and fines. That total does not include whatever amount Nebraska will owe Medicaid for a problem that HHS discovered this summer in the developmental disabilities division.

Agency officials found that the state had been paying for some services in a way contrary to the method approved by the federal government. About $32 million of payments to service providers are under review to determine how much needs to be repaid.

Phillips said HHS officials have been working to make sure federally supported programs actually are operating in accordance with federal requirements and agreements.

“We will continue to dig into our entire operation because the longer these things go on,” the more it costs, she said.