Medicaid Payments for School-Based Health Services Lynn, Massachusetts - July1999 Through June 2000

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether costs claimed for school-based health services by the Lynn 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 Lynn Public Schools inappropriately claimed the cost of school-based health services when documentation was inadequate, providers did not have the required qualifications, the student did not have a valid individualized education plan (IEP), the incorrect prototype was used and the school was closed for in-service days. As a result, we estimate that the Lynn Public Schools were overpaid at least $250,901. The Lynn Public Schools also received payments totaling $8,510 for days when the schools were not open (vacations, holidays, etc.). We made procedural recommendations to Lynn Public Schools to address these issues. We also recommended that the Lynn Public Schools refund amounts that were inappropriately paid by the Medicaid program.  Lynn Public Schools officials disagreed with the finding and recommendations regarding documentation of services, provider qualifications, and IEPs. They agreed with the findings and recommendations regarding prototypes and days when the schools were closed.

---