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EXECUTIVE SUMMARY:
The objective of this audit was to determine whether costs claimed for school-based health services by Rhode Island were allowable under the terms of the State Medicaid plan and applicable Federal or State requirements. We reviewed a statistically valid sample of 200 medical services from the State's two largest local education agencies (Providence and Pawtucket), which represented $82 million or about one-third of the State agency's claim for school-based health services. We concluded that 83 medical services (containing 99 payment errors) did not meet Medicaid reimbursement requirements. As a result, we estimate that at least $1.2 million (Federal share) was unallowable for reimbursement. Proper internal controls were not always established or sufficient because the local education agencies were not always made aware of all Medicaid billing requirements. Further, we found the State agency did not always provide sufficient oversight and monitoring of school-based services to ensure local compliance with Federal and State regulations and guidelines. We recommended a financial adjustment for $1.2 million, and procedural improvements to correct noted weaknesses.