Pennsylvania claimed $551M in Medicaid funds improperly, audit finds

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Pennsylvania has been accused of improperly receiving $551 million in Medicaid funds to go toward its school-based services. 

The U.S. Office of the Inspector General said in a report released Wednesday that the results of an audit on the state’s activities found that unallowable claims from July 1, 2015, through June 30, 2019 totaled $182.5 million. The audit examined around $590 million in federal Medicaid payments to the state in a “stratified random sample of random moments.”

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The Office of the Inspector General examined 310 random examples, each coded as an “administrative activity” or “health service,” and noted that these samples didn’t include all days worked by school staff because the first month of the school year was missing.

Officials said the state also improperly claimed an additional $368.9 million by using unsupported ratios when allocating costs to Medicaid. 

The Office of the Inspector General has recommended that Pennsylvania refund $182.5 million, and also give supporting documentation for the $368.9 million it claimed to prove how the costs were allocated, or refund that money as well.

The Office of the Inspector General said Pennsylvania claimed it was not required to provide additional documentation, and also not required to ensure service providers are properly licensed. 

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