State Won’t Recoup Medicaid Expenditures from Taos
February 1, 2010
Despite allegations of "Medicaid fraud" within the Taos Municipal School District by school board members, a state Medicaid School-Based Service spokeswoman said this week that the Medicaid School Health Office does not have any recent program review findings for Taos and will not seek to recoup funds from the district.
Allegations about Medicaid money being misspent within the district started becoming public last month.
Two board members indicated concerns about Medicaid expenditures on surveys sent to the Moss Adams auditing firm, which is conducing a $50,000 "forensic audit" of district finances.
The district recently provided The Taos News with documents detailing the Medicaid School-Based Service programs in Taos.
District records show a relationship between the district and the Rocky Mountain Youth Corps goes back several years; the "Learning Lab" agreement was renewed at the end of 2008, when Loretta DeLong was still superintendent.
A Dec. 15, 2009, e-mail from Taos Medicaid Facilitator Rayne Medina to the Medicaid School-Based Service states she "realized that we were paying a teacher’s salary (JoAnn Ortiz) at Rocky Mountain Youth Corps" and wondered whether that is a permissible use of Medicaid funds.
"A regular education teacher does not meet the requirements of spending the reimbursements on health and health-related services for all students, so it would not be acceptable to pay her salary w ith Medicaid funds," Human Services Department nurse consultant Suzy Whitehead responded Dec. 17.
According to information from Taos district Human Resources Director Angélica Vigil, Ortiz is a part-time district employee.
"Her contract, in the amount of $11,527, began on Jan. 13, 2009," Vigil wrote in an e-mail Jan. 26. "She does not receive benefits through the district. She gets paid from Medicaid funds."
Medicaid reimbursement forms from the 2008-2009 fiscal year show $15,216 of $120,483 was spent on a teacher from Rocky Mountain Youth Corps. Equipment, travel, training and supplies are among the other expenses listed for reimbursement.
Youth Corps Education Director Tia Trujillo said the Corps has "no control and/or say" over how the district spends its money; she said the local nonprofit only seeks to provide a service to struggling students with its Learning Lab program, and Ortiz acts as the certified teacher who oversees instruction, as required by the agreement with the district.
State guidelines for facilities participating in Medicaid School-Based Service allow for reimbursements for administrative expenses or direct services provided to eligible individuals, including therapies, counseling, nutritional evaluations, transportation and case management. Non-covered services include services classified as educational and vocational training that is related to "specific employment opportunities, work skills or work settings," according to an Medicaid School-Based Service guide.
District Exceptional Programs Coordinator Madelyn Marmol said she was unsure if the salary payments are permissible and said she had not heard anything recently from the Human Services Department.
However, that department conducted a site visit and audit of the district’s Medicaid School-Based Service program last April.
"We reviewed a total of 51 Medicaid direct service claims and three quarters of administrative claims," an April 17 letter from the Human Services Department to then-acting superintendent Alfred Córdova states.
The Human Services Department’s review in Taos turned up 10 findings, though payments for the Learning Lab were not among them. The findings included: "Some claims did not list the time or duration of service being provided," "some claims did not have progress notes," and "some claims missing provider credentials."
A May 5 letter from interim Superintendent Roberto "Bobby" Gonzales and then-coordinator of Exceptional Programs Jeanelle Livingston includes a "corrective action plan" to address the findings within the month.
Livingston wrote in an e-mail that the district worked closely with state offices on the procedures for planning and implementing the Medicaid School-Based Service program, which targeted students with "medical, health and health-related needs."
"To my knowledge … at no time did staff knowingly approve or use Medicaid funds away from the intent of the scope of work for students’ health or health-related needs," she wrote Jan. 19. "The programs and services that were funded supported students (who) were very at-risk with health or health-related issues. Why would anyone jeopardize funding for these very important and needed services for our students by not complying with Medicaid regulations and rules?"
McCracken wrote Tuesday (Jan. 26) that there have been no program-review findings regarding the district since the April site visit.
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"The Medicaid School Health Office will not seek recoupment of funds that may have previously been utilized for the instructor (Ortiz)," she wrote.