Review of Targeted Case Management Services Rendered by the Massachusetts Department of Social Services During Federal Fiscal Years 2002 & 2003

Medicaid pays for targeted case management services to assess Medicaid beneficiaries service needs, refer beneficiaries to needed services, and monitor the services. It does not pay for direct social services to which beneficiaries have been referred. However, Massachusetts included the costs for direct social services in the rates used to claim reimbursement for targeted case management services. OIG recommended that the State refund the resulting $87 million Federal overpayment and work with the Federal Centers for Medicare and Medicaid Services to determine the allowability of the remaining $13.5 million Federal share claimed. The $13.5 million claimed may have already been reimbursed under other Federal programs.

The auditors sought to determine whether the Massachusetts Office from Medicaid claimed claimed allowable Medicaid targeted case management services rendered by Social Services during Federal fiscal years 2002 and 2003.