Missouri Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services

The Missouri Department of Social Services (State agency) claimed Federal Medicaid reimbursement of at least $6 million (almost $3.8 million Federal share) for unallowable targeted case management (TCM) payments during Federal fiscal years 2014 and 2015. The State agency paid TCM providers and claimed unallowable Federal Medicaid reimbursement because its policies and procedures did not ensure that those providers complied with Federal and State requirements for documenting case managers' qualifications and for documenting and claiming TCM services. In addition, the State agency did not have policies and procedures to ensure that it correctly reported, in its claims for Federal Medicaid reimbursement, TCM paid claims it had recouped from a TCM provider.