Determine whether the Minisink Valley Central School District (District) maximized Medicaid reimbursements by submitting claims for all eligible Medicaid services provided.
The District did not maximize Medicaid reimbursements by claiming for all eligible Medicaid services provided.
- Claims were not submitted for reimbursement for at least 3,083 eligible services totaling $187,932. Had these services been claimed, the District would have realized revenues totaling $93,966 (50 percent of the Medicaid reimbursements).
- Between July 1, 2020 and December 31, 2021, the District paid a third-party vendor (vendor) $54,996 to process the District’s Medicaid claims. However, officials did not provide the vendor with all of the documentation needed for the vendor to properly file all Medicaid claims and did not adequately oversee the vendor to ensure Medicaid reimbursements were maximized.
- Establish procedures to ensure all documentation requirements are met to submit Medicaid claims for reimbursement for all eligible services provided.
- Review all unclaimed services and submit any eligible claims for reimbursement.
Except as specified in Appendix B, District officials agreed with our recommendations and indicated they have begun corrective action. Appendix C includes our comment on an issue raised in the District’s response.