The AuSable Valley Central School District could’ve been reimbursed for a total $56,510 in Medicaid claims over the past seven years, according to an audit by the state comptroller’s office.

The audit, which covers 2011 through 2018, says the money wasn’t reimbursed because the district lacked adequate procedures to ensure Medicaid claims were submitted for all eligible services. Not recording services, recording them improperly and providers not being enrolled in Medicaid are some of the reasons why the claims weren’t reimbursed.

Medicaid is a joint federal and state program that helps fund medical care for people with limited income and resources. It also has a program that fully reimburses the cost of services such as speech, physical and occupational therapy and skilled nursing provided to public school students with special needs. The state suspended the program in 2009, then reinstated it in 2010 with new reporting requirements and training.

In a statement attached to the audit, AuSable Valley Superintendent Paul Savage said that because of the reimbursement process changing in 2010, a longtime director of special education retiring and a lack of cooperation from outside service providers, the district missed out on unrealized revenues.

“Unrealized revenue is the key term there,” Savage said in a phone interview Wednesday. “It’s a part we hope to maximize in the future. Nothing was done inappropriately. It was just kind of a rash of issues in a row, some in our control, some out.”

District Businesses Manager Scott Brow said the school was working on fixing the reimbursement issues prior to comptroller’s audit.

Savage and Brow said at times it was difficult getting outside agencies like BOCES to record Medicaid services correctly. It’s easier working with in-house district employees, they said.

According to the audit, in the 2017-18 school year, one provider from an outside agency recorded speech therapy sessions for students in a notebook but failed to log them into Medicaid’s system. AuSable Valley administration didn’t find out until May 2018. As a result, the vendor was unable to submit claims on behalf of the school for therapy sessions during that time.

Savage and Brow said both teachers and outside agencies who can provide services eligible for Medicaid reimbursement are hard to come by in the North Country.

“Things like physical and speech therapy, those are the shortage areas,” Savage said. “There’s not an abundance of those out there.”

“If we wanted to do it all in-house, it would mean we’d have to hire more teachers, and that’s difficult in this climate,” Brow added.

Going forward, Savage and Brow said the district’s system for submitting claims to Medicaid works, but that they’ll have to monitor the logging of sessions more closely.

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Other districts

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Tupper Lake Central School District Business Manager Dan Bower said his district mainly hires district employees as Medicaid service providers. Like Savage and Brow, he said the North Country doesn’t have a lot of service providers.

“We’ve found that it can be difficult to hire a part-time person from something like BOCES,” he said. “In that respect, it’s easier to attract someone in the district.”

He agreed that when the process for reimbursement changed in 2010, it caused some confusion.

“Guidelines were kind of unclear for what could be claimed,” he said.

He also said certain services that were previously reimbursed, like transportation, are no longer.

“There are less services you can bill for than previously,” he said, “and when you consider the time and the man hours put into it, I’ve heard some say it could be more costly to file for reimbursement.”

Lake Placid Central School District Business Manager Dana Wood has been in the position since September, but he said as far as he knows, the district is up to date with all its reimbursement submissions. He said all of the school’s Medicaid service providers are teachers who work in the district.

“We typically don’t contract out for services,” he said. “It’s a whole different story for pre-school students, but the county takes care of that.”

Saranac Lake Central School District Business Manager Cindy Moody said her district works with both teachers and outside agencies, and both groups know how to log their sessions properly for Medicaid reimbursement.