Medicare Compliance & Reimbursement

Medicaid rules and regulations cast a wide net, and sometimes the fraud and abuse perils that lurk within the regulatory tangle snare unexpected victims. Case in point: School districts can bill Medicaid for some school-based health services, but the HHS Office of Inspector General has long worried that many districts just aren't getting the rules. But OIG anxiety isn't the end of the story - if blunders conceivably rise to the level of fraud, the stakes can be huge. Case in point: Oregon Attorney General Hardy Myers and U.S. Attorney Michael Mosman March 14 announced that the Beaver State's Gaston School District has agreed to pay more than $230,000 to resolve charges that it defrauded Medicaid. The alleged misconduct included failing to properly document claims, billing for non-reimbursable services and submitting claims for services students didn't actually receive. Gaston denies the charges. The case marks the second of its kind in Oregon. Previously, Eagle Point School District paid $1.2 million to resolve similar claims. Lesson Learned: Compliance experts should be aware that the nation's school districts are badly in need of Medicaid billing expertise.