Wisconsin May Have Improperly Claimed $455 Million in Medicaid Reimbursement for Its School-Based Program

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.

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.