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

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether Federal Medicaid payments for transportation services claimed by 695 school and preschool providers in New York were in compliance with Federal and State requirements.  We found that 97 of 110 transportation claims in our statistical sample did not comply with Federal and State requirements.  As a result, we estimate that $17.2 million in Federal Medicaid funding was unallowable.  We also set aside other claims totaling an estimated $35.8 million (Federal share) for consideration by CMS because Federal Medicaid law and regulations require that services be documented but do not specify how services should be documented.  In addition to a financial adjustment for $17.2 million, we recommended that the State work with the Centers for Medicare and Medicaid Services (CMS)to resolve the $35.8 million in set-aside claims, provide proper guidance on Federal and State Medicaid criteria to schools and preschools, reinforce the need for school health providers to comply with Federal and State requirements, and improve its monitoring of school health providers' transportation claims to ensure compliance with Federal and State requirements.