Medicaid Payments For School-Based Health Services Worcester, Massachusetts - July 1999 Through June 2000

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether costs claimed for school-based health services by the Worcester Public Schools through the Commonwealth of Massachusetts were reasonable, allowable and adequately supported in accordance with the terms of the State Medicaid Plan and applicable federal regulations.  The audit period included Medicaid payments made during the period July 1, 1999 through June 30, 2000.  We found that the Worcester Public Schools inappropriately claimed the cost of school-based health services when documentation was inadequate, the student was absent, and/or the wrong prototype was billed.  As a result, we estimate that the Worcester Public Schools were overpaid at least $67,777.  We recommended a financial adjustment and that the Worcester Public Schools develop and/or improve several procedures to ensure that the claim for federal reimbursement is based on an appropriate prototype related to documented services provided in response to a valid Individualized Education Plan for days on which the student attended school.  Worcester Public Schools officials generally agreed with our procedural recommendations, but did not express agreement or disagreement regarding the refund of the $67,777.

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