Finding 1164427 (2024-003)

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program Federal Assistance Listing Number: 93.778 Pass-Through Agency: WI DHS Pass-Through Numbers: N/A Award Period: January 1, 2024 – December 31, 2024 Type of Finding Significant Deficiency in Internal Control Over Compliance, Other Matters Compliance Requirement Allowable Costs Criteria The County’s Human Services Department must authorize services for children enrolled in the Children’s Long-Term Support (CLTS) Program. When services are provided by third-party vendors, those vendors submit their costs to the Third-Party Administrator (TPA), which processes reimbursements directly through the CLTS Program. Condition The County authorized a vendor to provide services to a child enrolled in the CLTS program through December 31, 2024. However, after the child relocated out of the County, the County had updated the child’s Individual Service Plan for the service to end effective September 30, 2024. The provider continued to submit claims and received reimbursement through the CLTS Third Party Administration system for services rendered in October, November, and December. Questioned Costs The provider received reimbursement at $75.30 per month for three months for a total of $225.90. Context Of the nine expenditures tested one was not allowable. Cause The County did not have a procedure in place to review the monthly services billed by third party vendors to the CLTS Third Party Administration to ensure that only allowable activities were being reported. Effect A provider billed and received payment for services that were not eligible for reimbursement. Repeat Finding No Recommendation We recommend that the County implement a procedure by which a monthly review of the activities billed by providers to the CLTS Third Party Administration is performed with special attention on any authorized changes in services that occurred during the month. Views of Responsible Officials There is no disagreement with this finding