The Colorado Department of Health Care Policy and Financing (State agency) claimed Federal Medicaid reimbursement for some Targeted Case Management (TCM) services that did not comply with Federal and State requirements for fiscal years (FYs) 2014 and 2015. Of the 150 randomly sampled TCM claims we reviewed, 49 claims were unallowable because they had at least 1 of the following errors (some claims had more than 1 error): (1) the TCM providers could not provide documentation supporting that the case managers had the qualifications-that is, the education or experience-required by the Colorado TCM State plan amendment (43 claims); (2) the TCM providers could not provide documentation to support that they had actually provided 1 or more TCM services to the Medicaid recipients (10 claims); (3) the TCM providers' case notes lacked sufficient detail to support that claimed services were allowable (5 claims); and (4) the TCM providers were unable to provide complete documentation of recipients' eligibility for TCM services (3 claims).
CO
United States
