Medicaid School-Based Costs Claimed Based on Contingency Fee Contractor Coding
Several State Medicaid agencies retain consultants to assist with preparing Medicaid claims for school-based activities. Consultants often are paid a contingency fee based on the percentage of Federal funds reimbursed to the State. During a prior review, we found that one consultant developed unsupported timestudies that it used to develop payment rates for school-based health services. Based on those rates, the State claimed unallowable Federal funds. Consultants developed timestudies using a similar methodology in many other States. We will initiate a multiple State review with a roll-up report to CMS to determine whether consultants developed school-based Medicaid rates based on unsupported timestudies and unallowable costs in these States
Announced or Revised | Agency | Title | Component | Report Number(s) | Expected Issue Date (FY) |
---|---|---|---|---|---|
Completed (partial) | Centers for Medicare & Medicaid Services | Medicaid School-Based Costs Claimed Based on Contingency Fee Contractor Coding | Office of Audit Services | A-04-18-07075; W-00-18-31529; A-02-20-01012; A-02-18-01019 |
2024 |