Review of Medicaid Speech Claims Made by School Health Providers in New York State

EXECUTIVE SUMMARY:

The objective of the audit was to determine whether Medicaid reimbursement for speech services claimed by 711 school and preschool providers in New York from September 1993 through June 2001 were allowable under Federal and State law.  Based on a statistically valid sample, we estimate that providers claimed approximately $172.6 million (Federal share) for speech services that were not allowable for reimbursement.  The claims were unallowable mostly because services lacked a referral by an appropriate medical professional, and/or the services did not comply with Federal law requiring that speech services be provided by or under the direction of a certified speech-language pathologist or an individual with similar qualifications.  Among other things, we recommended a financial adjustment for the $172.6 million, and that New York provide proper and timely guidance on Federal Medicaid criteria to schools and preschools.  New York generally disagreed with our findings and recommendations.