School districts appeal Medicaid ruling

Carson, Washoe and Clark county school districts have appealed a state ruling that accused them of double billing Medicaid services.

The case filed in Carson District Court on March 28 seeks judicial review of the hearing officer's decision in the case.

The 2003 law allows school districts to bill Medicaid for a portion of the costs in setting up Individual Education Plans for disabled, emotionally disturbed and other students who qualify for Medicaid and need special services from public schools.

But after parents called the state complaining they weren't certain their children were actually receiving the services they are entitled to, the Division of Health Care Financing and Policy had its review unit look into the situation. The investigation, according to state officials, revealed the three school districts billed improperly and received payments in excess of what they were entitled to. The state claims it is owed a total of $1.44 million by the three districts.

The state ruling on the case states the school districts were billing for both an IEP-1 and IEP-2 on the same day, which state officials argued is prohibited.

"The districts' practice of billing twice for many IEP's was not a practice accepted or approved by Nevada Medicaid," the hearing decision stated. It added that Charles Duarte, head of the division, said he would consider that practice "double billing."

The districts were accused of billing Maximus, the state's contractor for the Medicaid payments, twice for developing numerous IEPs for students.

According to the hearing officer's decision, the practice "ignored the plain language" of the regulations controlling that funding.

According to court documents, Carson School District owes the state $109,167, Washoe $233,865 and Clark $1.1 million.

The districts have petitioned for Carson District Judge Bill Maddox to reverse the decision saying the state ruling violates both constitutional and statutory provisions and is "clearly erroneous."

Maddox has not yet agreed to review the case, therefore no briefs have yet been filed detailing arguments by the school districts.

• Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750.