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Audit (A-01-11-00011)

04-29-2013
Maine Improperly Claimed Medicaid Payments for School-Based Health Services Submitted by Portland School Department

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Summary

Department of Health and Human Services, Office of MaineCare Services (State agency), did not always claim Federal Medicaid reimbursement for school-based health services submitted by the Portland (Maine) School Department in accordance with Federal and State requirements. Of the 120 student months in our random sample, 56 had services that were not adequately supported, were provided by unqualified providers, or both. Based on our sample results, we estimated that the State agency improperly claimed $668,000 Federal share for Medicaid payments made to the Portland School Department. These errors occurred because the State agency did not adequately monitor the claims for Medicaid school-based health services submitted by the Portland School Department.

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