Series: Medicaid School-Based Costs Claimed Based on Contingency Fee Contractor Coding

OBJECTIVE

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 time studies that it used to develop payment rates for school-based health services. Based on those rates, the State claimed unallowable Federal funds. Consultants developed time studies 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 time studies and unallowable costs in these States

There are 2 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (1)

COMPLETED PROJECTS IN THIS SERIES (1)

Pennsylvania

Project A-02-21-01011 • Completed on March 11, 2024

TIMELINE

• March 3, 2021
  Series Number W-00-24-31529 Assigned
• March 3, 2021
  Project Announced

  Pennsylvania - A-02-21-01011

• March 11, 2024
  Project Complete - A-02-21-01011

  Pennsylvania has been marked as complete. This audit resulted in 6 recommendations.

• October 17, 2024
  Project Announced

  Project A-02-24-01020

• Today
  1 Audit In-Progress
• Est FY2026
  Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

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