Mayfield Central School District – Medicaid Reimbursements (2019M-149)

Issued Date
October 25, 2019

[read complete report - pdf]

Audit Objective

Determine whether the District claimed all Medicaid reimbursements to which it was entitled for services provided to eligible special education students.

Key Findings

  • The District lacked adequate policies and procedures to ensure Medicaid claims were submitted and reimbursed for all eligible services provided.
  • Claims were not submitted and reimbursed for 312 eligible services totaling $11,896 and service providers (providers) did not document 948 scheduled services totaling $69,324 in the special education system (system) as provided. Had these services been appropriately documented and claimed, the District could have realized potential revenues totaling $40,610.
  • Service records were not available for 10 students. As a result, we could not determine whether the District submitted all eligible claims for these students.

Key Recommendations

  • Establish adequate policies and procedures for Medicaid reimbursement.
  • Review all unclaimed services and submit any eligible claims for reimbursement.
  • Ensure providers document all service encounters in the system.

District officials generally agreed with our recommendations and indicated they planned to initiate corrective action.