A federal audit accuses the state of over-billing Medicaid by $20.5 million.

The audit claims that Missouri overcharged the federal government for Medicaid administrative costs at schools that provide health care for poor children and those with disabilities. The results have been forwarded to the Centers for Medicare and Medicaid Services which could demand the state refund the money. A spokesman for the Missouri Department of Social Services disputes the findings of the audit, saying that the state followed federal guidelines and had approval to operate in the manner that it did.

An auditor with the United States Department of Health and Human services conducted a review of Medicaid expenditures at schools in St. Louis and Springfield from 2004 to 2006. The alleged overbilling centers on how much time school employees have to spend on administering the federal school-based health programs.

The state could appeal any decision made by the Centers for Medicare and Medicaid Services. The case could ultimately be decided by a federal judge.