Montana Claimed Federal Medicaid Reimbursement for More Than $5 Million in Targeted Case Management Services That Did Not Comply With Federal and State Requirements

Date Issued

Friday, August 26, 2022

Submitting OIG

Department of Health & Human Services OIG

Agencies Reviewed/Investigated

Department of Health & Human Services

Report Number

A-07-21-03246

Report Type

Audit

Agency Wide

Yes

Number of Recommendations

Questioned Costs

Funds for Better Use

Hide this report from display

Yes

Open Recommendations

This report has 3 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
22-A-07-08601	No	$5,065,966	$0
We recommend that the Montana Department of Public Health and Human Services refund to the Federal Government $5,065,966 (Federal share) in overpayments.
22-A-07-08602	No	$0	$0
We recommend that the Montana Department of Public Health and Human Services ensure that it always follows its established policies and procedures by: o reviewing TCM providers' case manager hiring practices to verify adherence with the State plan's experience requirements and to ensure that case managers'qualifications were documented, o implementing a process to review billed services to verify that they were allowable and properly documented, and o reviewing target group eligibility documentation to ensure that all individuals receiving services were eligible.
22-A-07-08603	No	$0	$0
We recommend that the Montana Department of Public Health and Human Services require TCM providers to comply with established policies and procedures in order to ensure that: o case managers who render TCM services to recipients have the experience required by the State plan supplement, o TCM providers maintain documentation to support the TCM services rendered, o TCM providers maintain documentation to support that case managers are qualified to perform TCM services, o the State agency does not pay TCM providers or claim Federal Medicaid reimbursement for services that are not allowable TCM services, and o recipients receiving TCM services are eligible to receive those services.