Iowa Medicaid payments for targeted case management
Healthcare Auditing Weekly, November 26, 2007
The OIG found that the Iowa Department of Human Services improperly claimed $2,495,948 for targeted case management (TCM) services that did not comply with federal and state requirements. Of the 200 agency claims, 127 were allowable, 60 were claimed improperly, and 13 may have not been allowable, according to the OIG audit.
The OIG recommended:
- The Iowa Department of Human Services refund $1,510,153 to the federal government for unallowable TCM claims
- The agency work with CMS to determine the allowability of the $196,116 of direct medical services incorrectly claimed as TCM services
- The agency create policies and procedures to strengthen its internal controls to ensure compliant federal reimbursement
The Iowa Department of Human Services said it did not agree with the OIG's first two recommendations but agreed with the last.
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