Series: Medicaid School-Based Costs Claimed Based on Contingency Fee Contractor Coding

OBJECTIVE

Several State Medicaid agencies retain consultants to assist with preparing Medicaid claims for school-based activities. Consultants often are paid a contingency fee based on the percentage of Federal funds reimbursed to the State. During a prior review, we found that one consultant developed unsupported time studies that it used to develop payment rates for school-based health services. Based on those rates, the State claimed unallowable Federal funds. Consultants developed time studies using a similar methodology in many other States. We will initiate a multiple State review with a roll-up report to CMS to determine whether consultants developed school-based Medicaid rates based on unsupported time studies and unallowable costs in these States

There are 2 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (1)

Project A-02-24-01020 • Announced on Oct 17, 2024

COMPLETED PROJECTS IN THIS SERIES (1)

Pennsylvania

Project A-02-21-01011 • Completed on March 11, 2024

TIMELINE

• March 3, 2021
  Series Number W-00-24-31529 Assigned
• March 3, 2021
  Project Announced

  Pennsylvania - A-02-21-01011

• March 11, 2024
  Project Complete - A-02-21-01011

  Pennsylvania has been marked as complete. This audit resulted in 6 recommendations.

• October 17, 2024
  Project Announced

  Project A-02-24-01020

• Today
  1 Project In-Progress
• Est FY2026
  Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

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