Review of Medicaid School-Based Services Claimed During State Fiscal Year 2000 by Maryland's Medicaid Program

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicaid costs claimed for school-based health services by Maryland's Department of Health and Mental Hygiene (DHMH) were reasonable, allowable, and adequately supported in accordance with the terms of applicable federal regulations and the state Medicaid plan.  We identified internal control weaknesses that need to be corrected to ensure that Maryland's school-based payment rates are based on actual costs of providing medical services and service providers appropriately submit and document Medicaid claims for school-based health care services.  Our review of payments in 100 randomly selected recipient/months showed that DHMH billed the Medicaid program:  (1) when providers were not qualified to render the service; (2) for services that were not approved in the state plan; (3) when the student was absent or the service did not occur with the appropriate participant; (4) for services that were not authorized or authorized Medicaid service on the same day; and (6) for services that were insufficiently documented.  Based on a projection of the statistical sample, we estimated overpayments to be approximately $20 million in federal Medicaid matching funds.