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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 policies and procedures to ensure Medicaid claims were submitted and reimbursed for all eligible services provided.
• Claims were not submitted and reimbursed for 312 eligible services totaling $11,896 and service providers (providers) did not document 948 scheduled services totaling $69,324 in the special education system (system) as provided. Had these services been appropriately documented and claimed, the District could have realized potential revenues totaling $40,610.
• Service records were not available for 10 students. As a result, we could not determine whether the District submitted all eligible claims for these students.

Key Recommendations

• Establish adequate policies and procedures for Medicaid reimbursement.
• Review all unclaimed services and submit any eligible claims for reimbursement.
• Ensure providers document all service encounters in the system.

District officials generally agreed with our recommendations and indicated they planned to initiate corrective action.