School districts fail to recover Medicaid money

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October 3, 2008

By STEPHEN BARTLETT The Press Republican Fri Oct 03, 2008, 12:00 AM EDT

PLATTSBURGH -- Local school districts are keeping a closer eye on Medicaid reimbursements since New York state's announcement of millions in losses.

Actually, that estimate is much smaller when examining what each individual district lost.

School officials say they've already begun making the changes to ensure they don't miss out on that money in the future, though at the same time they are frustrated with the never-ending changes in the process.

"The ground rules have changed, and almost quarter to quarter, it becomes more stringent," said Peru Central School Superintendent A. Paul Scott. "The guidelines for districts to receive reimbursements for services provided have become more stringent, and the amount of funds available seem to be shrinking.

"That will be an ongoing challenge in the years ahead, especially during this economic downturn."

Weak internal controls and policies prevented eight school districts throughout northeastern New York from claiming at least $3.1 million in Medicaid reimbursable expenses, according to a news release from State Comptroller Thomas P. DiNapoli's office. As a result, the districts lost out on $1.54 million in revenue for the schools and state to share.

In Clinton, Essex and Franklin counties, the schools listed in the report are Peru, Plattsburgh, Salmon River and Saranac.

"School districts are struggling to fund educational programs with limited resources, and every nickel matters," DiNapoli said. "Medical reimbursements are an important revenue source for school districts and the state. The money is being spent, the services are being provided, and districts should go after the reimbursement."

The audit covered the period of July 2005 to June 2007. School districts and New York state are each entitled to 25 percent of such expenses from the federal government. By failing to claim the Medicaid expenses, districts collectively lost out on $770,000, with the state missing out on the same amount.

Reasons given by school districts for failing to claim the money included untimely identification of Medicaid-eligible students, difficulty obtaining proper documentation, irregularly claiming bills resulting in a backlog of claims and not reviewing denials to possibly resubmit for reimbursement.

"It had just been during the past couple years that the School Board and administration had been working on strengthening Medicaid reimbursement procedures," Scott said. "The time looked at was before the time period Peru Central moved ahead with some initiatives to strengthen Medicaid reimbursement."

Peru officials lost out on nearly $110,000.

"We are now in a position where we are much more likely to receive the amount of reimbursement we are eligible for," Scott said. "We are in the process of seeking the unclaimed reimbursements."

School districts may be able to get all or most of the money they failed to claim.

Plattsburgh City School could have collected another $33,805.

"A few years ago, it was more than $348,000," said Superintendent James "Jake" Short. "When that occurred, we had our own auditing process and had to hire an additional person to redo Medicaid billing.

"We had a 90-percent improvement since then and have improved it much over the past few years, but there is still room to go."

Short was pleased with the audit and the way in which it was conducted, though, like Scott, he is concerned with constant evolutions in Medicaid-reimbursement guidelines.

"The process is constantly changing and has become incredibly complex."

For some, the process was enlightening.

"I joined the district a year ago, and it was very helpful to examine what practices and procedures we have in place," said Salmon River Central School Superintendent Jane Collins.

Salmon River missed out on about $50,000 for the time period covered by the audit.

"The issue here is we have had such a turnover in staff that we needed to create procedures and ensure documentation for the appropriate transmittal of Medicaid claims in a timely manner," Collins said. "We have addressed that."

Others welcomed the audit.

"The purpose was to assist school districts to improve their operational procedures and maximize revenues," said Saranac Central School Superintendent Ken Cringle. "We have taken steps to improve our procedures."

He didn't know the exact amount the district would have received but said Saranac would recover a substantial portion of the amount covered in those areas.

"I think we welcome any audit because it provides us an extra set of eyes and expertise to enhance our procedures."

sbartlett@pressrepublican.com