Medicaid Payments For School-Based Health Services Holyoke, 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 Holyoke 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 Holyoke Public Schools inappropriately claimed the cost of school-based health services: (1) when personnel did not possess required qualifications, (2) when the school system did not locate any documentation to demonstrate that services prescribed in the individualized education plan (IEP) were delivered, (3) for students who were not prescribed to receive: services by a current IEP, (4) for the wrong prototype, and (5) when students were absent. As a result, we estimate that the Holyoke Public Schools were inappropriately overpaid at least $191,551. We recommended that the school system develop and/or improve procedures to ensure that: all health services are rendered by Medicaid eligible providers; service providers document all health services delivered to Medicaid recipients; Medicaid billings are based on accurate attendance records, and students have a current IEP that prescribes direct services; and the correct prototype is used. We also recommended that school system refund amounts that were inappropriately paid. Holyoke Public School officials generally agreed with the procedural recommendations and stated they are developing written policies and were taking corrective action.

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