The Office of Inspector General (OIG) recently released an audit report that examined payment rates for targeted case management (TCM) services provided and paid for by the state in fiscal years 2011 through 2013. The OIG found that the state agency did not calculate the rebased payment rate that was effective at the beginning of FY 2011 in accordance with the state plan. The state agency raised rates in FY 2012 and FY 2013, but the payment rate was incorrect because of the incorrect calculation.
Based on its findings, the OIG recommends that the state refund $11.5 million to the federal government that was claimed improperly. Additionally, the report urges that future payment rates for TCM services be calculated appropriately and that the state agency works with CMS to determine additional unallowable payments that should be refunded to the federal government.