Review of Maine's Medicaid Retroactive Claims for School-Based Health Services - January 2001 Through June 2003

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether Maine's State agency's retroactive claims for Medicaid school-based health services complied with Federal regulations.  The State agency did not follow Federal regulations when it processed the retroactive claims for Medicaid school-based health services and did not incur any expenditures because it did not remit the Federal share received for these claims to the provider school districts.  The State agency was overpaid $3,044,211 (Federal share).  We recommended that the State agency refund the $3,044,211 to the Federal Government and follow prescribed procedures to ensure that the State properly refunds the Federal share for uncashed or voided checks in accordance with Federal requirements.  The State agency did not agree to repay the $3,044,211.  However, the State agency agreed that the payment procedures it used to process claims for retroactive school-based costs were inappropriate and said that it would work with CMS to develop an acceptable payment process.

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