Cohoes City School District – Medicaid Reimbursements (2022M-107)

Issued Date
December 02, 2022

[read complete report – pdf]

Audit Objective

Determine whether the Cohoes City School District (District) maximized Medicaid reimbursements by submitting claims for all services provided to Medicaid eligible students with signed parental consent forms.

Key Findings

The District did not maximize Medicaid reimbursements by submitting claims for all eligible Medicaid services provided. We reviewed reimbursements for 20 eligible students, or 13 percent of the eligible student population.

  • Claims were not submitted for 814 eligible Medicaid services. Had these services been claimed, the District could have realized reimbursements totaling $12,603.
  • The District lacked adequate procedures and did not provide supervision to ensure Medicaid claims were submitted and reimbursed.

Key Recommendations

The Director of Special Programs should:

  • Establish procedures to ensure all documentation requirements are met to submit Medicaid claims for reimbursement for all eligible services provided.
  • Ensure, session notes are entered in the billing system in a timely manner.
  • Ensure billing reports are reviewed every billing cycle to identify issues needing correction and follow up with providers to resolve issues and re-submit the claims.

District officials generally agreed with our recommendations and have initiated, or indicated they planned to initiate corrective action.