Wisconsin May Have Improperly Claimed $455 Million in Medicaid Reimbursement for Its School-Based Program
Learn how the AI-generated research projects were createdOverall Conclusion
Wisconsin may have improperly claimed Federal Medicaid reimbursement for its school-based program, and the OIG issued six recommendations to recover funds or support costs and to strengthen RMTS and related controls.
Source Document
Audit Scope
Examination of Wisconsin's Medicaid school-based program reimbursements claimed during a four-year period, with focus on RMTS processes, cost allocation, licensing verification, and documentation.
Key Findings Summary
Wisconsin may have improperly claimed an estimated $454.9 million in Federal Medicaid reimbursement for its school-based program.
At least $67 million improperly claimed based on unsupported RMTS coding and services provided by unlicensed providers.
An additional $387.9 million improperly claimed because it could not provide documentation to support ratios used to allocate costs to Medicaid.
View the Findings tab to see all 4 findings
AI-Assisted
AI Scope Summary
The audit objective was to determine if Wisconsin properly claimed Medicaid school-based program reimbursements over a four-year period, focusing on RMTS methodology, documentation, and licensing verifications. The four-year scope and the finding of potential improper claims led to six recommendations to recover funds or strengthen controls for future audits.
AI-Generated Insight
The audit identifies material risks in the state's RMTS implementation and cost allocation processes, with an estimated $454.9 million in potentially improper Medicaid reimbursements and six recommendations to enhance accountability, documentation, and licensing verification.
Audit Objectives
Determine whether Wisconsin properly claimed Medicaid reimbursement of $505.5 million in school-based program services during a four-year period.
Audit Findings (4)
Wisconsin may have improperly claimed an estimated $454.9 million in Federal Medicaid reimbursement for its school-based program.
At least $67 million improperly claimed based on unsupported RMTS coding and services provided by unlicensed providers.
An additional $387.9 million improperly claimed because it could not provide documentation to support ratios used to allocate costs to Medicaid.
Additional unallowable costs because RMTSs did not sample moments during the beginning of the school year.
Recommendations (6)
Refund the estimated $67,042,719 to the Federal Government related to moments that could not be supported as Medicaid-eligible health services or Medicaid administrative activities.
Provide documentation that can reasonably support its allocation of health services costs to Medicaid or refund $387,870,393 to the Federal Government.
Ensure that its contractor obtains sufficient information so that the Wisconsin Department of Health Services can validate the contractor's coding of RMTS moments.
Ensure that school districts verify and document that providers are appropriately licensed or under the direction of licensed providers before they provide health services to students.
Develop an accurate, supportable method to identify Medicaid costs that can be verified with source documents.
Revise RMTSs to include the beginning of the school year.