Medicaid Examination Finds $378,068 in Overpayments to Riverside Local School District

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Columbus – The Riverside Local School District’s (Lake County) former billing company erroneously doubled the amount of Medicaid services it billed to the state, contributing to $378,068 in overpayments to the district.

A report released today by Auditor of State Dave Yost cites 885 errors in a sample of 1,059 services provided by the district between July 1, 2011 and June 30, 2014. The Ohio Department of Medicaid (ODM) reimbursed the district $808,968 for 10,275 services during the period. With interest, the district owes ODM $403,043.

The review found 560 instances where the units billed exceeded those recorded on service documentation. The majority of the errors stemmed from a system error that caused the district’s third-party billing vendor to incorrectly double the amount of units billed for several years. The district has since terminated its contract with the vendor.

“You shouldn’t put all your faith in the hands of a third-party vendor,” Auditor Yost said. “There needs to be a follow-up process to ensure the reimbursements agree with the services billed. I’m pleased to see the district is already taking steps to prevent future errors.”

Auditors determined the documentation for another 276 services did not include descriptions of the services provided. In three other instances, attendance records indicated the documented recipients were absent on the dates of services. 

During a review of Individualized Education Programs (IEPs), which are required for recipients of special education services, auditors noted the following 45 errors related to a handful of students:

  • 33 services with no prescription or plan of care from a physician authorizing the service;
  • 9 services that were not authorized on an IEP; and
  • 3 services that lacked IEPs to support the services.

A full copy of this report is available online.  

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The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies.  Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.

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