Medicaid Payments for School-Based Health Services Boston, 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 Boston 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.

Boston Public Schools claimed the cost of school-based health services although documentation was inadequate, providers did not have required qualifications, the Individual Education Plan was invalid, students were absent, and for days when schools were not open to students.  As a result, we estimate that the Boston Public Schools were overpaid at least $1,240,526.  We made procedural recommendation to address these issues.  We also recommended that Boston Public Schools refund amounts that were inappropriately paid by the Medicaid program.  Boston Public Schools officials disagreed with the findings and recommendations regarding documentation of services and provider qualifications.  They agreed with the findings and recommendations regarding attendance, Individual Education Plans, and prototype records.

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