Audit of Medicaid Claims for Iowa Rehabilitation Treatment Services Family-Centered Program

EXECUTIVE SUMMARY:

The objective of this review was to determine whether the amounts claimed by the State of Iowa for the Rehabilitative Treatment Services Family-Centered Program met Medicaid reimbursement requirements in Federal fiscal year (FFY) 2001. Fifty-one of the 100 claims in our sample were unallowable because they were not in compliance with applicable criteria, including the Iowa State plan and the Iowa Administrative Code.  Of the 51 unallowable claims, 26 contained more than 1 deficiency.  The unallowable claims occurred because the State lacked adequate internal controls over the Family-Centered Program to ensure proper delivery of services for Medicaid reimbursement.  As a result, during FFY 2001, we estimate that the State claimed unallowable Federal Medicaid funding totaling $2,536,187.  We recommended that the State (1) refund $2,536,187 to the Federal Government, and (2) strengthen policies and procedures to ensure that Medicaid payments are based on services directed exclusively to the rehabilitative treatment needs of the child as defined in the Iowa State plan and are provided in compliance with State and Federal regulations.