The Office of the State Comptroller said Monday that the Auburn Enlarged City School District may have failed to claim up to $481,500 in Medicaid funds, according to an audit that district officials say is flawed.
Auditors said the district failed to process all claims for 26 Medicaid-eligible students individualized education plans, failed to identify the Medicaid-eligibility status of 12 Medicaid-eligible students with IEPs or submit claims for services they received, and failed to identify the potential Medicaid eligibility status of another six students with IEPs who received free school lunches.
"The district did not get reimbursed for these services because district officials had not established policies and procedures for controlling the Medicaid reimbursement process," the audit, which covered a period from July 1, 2008 to April 7, 2010, stated.
The comptroller extrapolated the losses from the sample of cases it reviewed out to the district's entire special education student population to get the $481,500 figure, according to the report.
The report suggests the district can still submit eligible 2008-09 school year claims for reimbursement due to a two-year window for submission.
District officials disagree with many of the comptroller's findings and with the suggestion they submit old claims to Medicaid.
The district's defense to many of the audit findings was that different state offices have advised different courses of action for the district, resulting in the district's following one set of rules while seemingly ignoring another, said district Medicaid compliance officer Camille Johnson, who is also the assistant superintendent for student services.
"It's crystal clear that different agencies are giving us conflicting information," she said. "There's information coming to the district that tells us we would be making false claims (if we claimed retroactively within the two-year window)."
Johnson and other district officials said they have been receiving conflicting directives on Medicaid claims from two state offices, the Office of the State Comptroller and the Office of the Medicaid Inspector General. Since making a false Medicaid claim could result in expensive fines and criminal charges, Johnson said the district has been erring on the side of caution when getting conflicting advice from the two state offices.
"A false claim would be financially detrimental to the district," she said. "The False Claims Act penalties range from a minimum of $5,500 to $11,000 per claim, in addition to three times the amount of each claim plus attorney's fees."
See Tuesday's edition of The Citizen for more on this story.