Department of Health and Human Services

Office of Inspector General -- AUDIT

Complete Text of Report is available in PDF format (3.03 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

The costs that the State agency claimed for Medicaid targeted case management (TCM) services provided by the Maine Bureau of Child and Family Services during fiscal years 2002 and 2003 were not always in accordance with Federal and State requirements.  As a result, the State agency overstated TCM costs by a total of $44,213,815 ($29,759,384 Federal share).  We were unable to express an opinion on the remaining $12,387,285 ($8,327,896 Federal share) claimed.

We recommended that the State agency (1) refund to the Federal Government $29,759,384 in unallowable costs claimed for TCM services; (2) work with the Centers for Medicare and Medicaid Services to determine the allowability of the $8,327,896 Federal share on which we were unable to express an opinion; (3) identify and refund to the Federal Government any TCM costs that represent excessive reimbursement, direct social services, and nonreimbursable administrative costs reimbursed after the audit period; and (4) establish procedures to ensure that claims for Medicaid TCM reimbursement include only allowable and adequately documented TCM costs.  The State agency disagreed with the findings and recommendations.