[read complete report - pdf]

Audit Objective

Determine whether the District claimed all Medicaid reimbursements to which it was entitled for services provided to eligible special education students.

Key Findings

• The District lacked adequate procedures to ensure Medicaid claims were submitted and reimbursed for all eligible services provided.
• Claims were not submitted and reimbursed for 1,674 eligible services totaling $58,965 and service providers did not document 1,593 scheduled services totaling $54,054 in the special education system (system) as having been provided to students. Had these services been appropriately claimed and documented, the District could have realized potential revenues totaling $56,510.
• District officials did not submit any claims for reimbursement from 2011-12 through 2014-15 or submit claims for all eligible services provided from 2015-16 through 2017-18 due to inadequate procedures.

Key Recommendations

• Establish procedures to ensure all documentation requirements are met to submit Medicaid claims for reimbursement for all eligible services provided.
• Review all unclaimed services, determine whether these services are reimbursable and submit any eligible claims for reimbursement.
• Ensure service providers document all service encounters in the system.

District officials generally agreed with our recommendations and have initiated, or indicated they planned to initiate corrective action. Appendix B includes our comment on an issue that was raised in the District’s response letter.