Finding 517442 (2024-001)

Finding #2024-001: #93.778 Medical Assistance Program – SBS Medicaid Department of Health Services Audit Guide – 3.9.3.1 Activities Allowed and Disallowed Federal Grantor: U.S. Department of Health and Human Services Pass-through Entity: Wisconsin Department of Health Services Criteria: All services billed (SBS) must be identified in the students’ IEP. Cost reimbursement is disallowed for Medicaid-coverable services not specified in the student’s IEP. Condition: Two students from the auditor’s sample were billed for nursing services that were not included in the students’ IEPs. Cause: The District billed for services that were not listed on the students’ IEPs. Effect: Billing for services not listed on the IEP is not allowed and may result in improper use of federal funds. Questioned Costs: $1,670 Recommendation: The District should review procedures with the third party billing service to ensure there is proper communication regarding the allowed services being billed under IEPs. Additionally, the District should implement regular review of billed services to verify compliance with Medicaid requirements and ensure that all billed services are properly documented with students’ IEPs. Response: The District will implement a process to verify all billed services are documented in the IEPs and provide training to staff to prevent future occurrences.