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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Wisconsin Medicaid School-Based Services Program for the Year Ending June 30, 2000," (A-05-02-00023)

March 17, 2003

Complete Text of Report is available in PDF format (557 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether the Wisconsin Medicaid School-Based Services (SBS) program was effectively and efficiency managed by the Wisconsin Department of Health and Family Services (DHFS) and the SBS providers.  Our review showed the Wisconsin DHFS and SBS providers generally managed the SBS program in a effective and efficient manner.  We did, however, identify some areas needing improvement:  (1) the administrative cost calculation used an unrestricted indirect cost rate which included indirect costs not necessary for the management of the Medicaid program, and (2) providers did not always bill for SBS identified in individual education plans, properly bill on dates beneficiaries received services, or maintain required supporting documentation.  As a result, we determined that the Wisconsin DHFS and SBS providers claimed and received at least $315,474, in Medicaid federal financial participating (FFP) for costs not allowed or supported by adequate documentation during state fiscal year ending June 30, 2000.  In regard to the indirect cost rate issue, we recommended DHFS work with the Centers for Medicare and Medicaid Services to establish the appropriate indirect cost rate.  We also recommended the Wisconsin DHFS:  (1) refund $315,474 in FFP for costs not allowed or supported by adequate documentation, and (2) reemphasize Medicaid policies to providers and require them to implement effective internal controls to ensure SBS are properly provided, billed, and documented.