Medicaid School-Based Costs Claimed Based on Contingency Fee Contractor Coding

Several State Medicaid agencies retain consultants to assist with preparing Medicaid claims for school-based activities. Consultants often are paid a contingency fee based on the percentage of Federal funds reimbursed to the State. During a prior review, we found that one consultant developed unsupported timestudies that it used to develop payment rates for school-based health services. Based on those rates, the State claimed unallowable Federal funds. Consultants developed timestudies using a similar methodology in many other States. We will initiate a multiple State review with a roll-up report to CMS to determine whether consultants developed school-based Medicaid rates based on unsupported timestudies and unallowable costs in these States

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
Completed (partial)	Centers for Medicare & Medicaid Services	Medicaid School-Based Costs Claimed Based on Contingency Fee Contractor Coding	Office of Audit Services	A-04-18-07075; W-00-18-31529; A-02-20-01012; A-02-18-01019	2025