December 6, 2007

Review of Medicaid Targeted Case Management Services Rendered by the Georgia Department of Juvenile Justice During Federal Fiscal Years 2003 & 2004

In 2003 and 2004, the Georgia Department of Juvenile Justice (DJJ) claimed an estimated $2.8 million in unallowable targeted case management (TCM) services for Medicaid-eligible youth with emotional disturbances or substance abuse disorders who were at-risk of incarceration, according to federal auditors. DCH will repay the unallowable claims to the federal government once a final determination is made. The services were unallowable because neither DJJ nor the Georgia state Medicaid agency, the Department of Community Health (DCH), had adequate controls to ensure that the services were eligible TCM services. Of 100 claims reviewed by the federal Office of the Inspector General, 40 had errors including:

• 21 claims were for services that were not supported as TCM by DJJ case records

• 15 claims were for services that did not meet TCM requirements because the claims were for services provided to incarcerated juveniles and thus not part of the targeted at-risk population

• 4 claims lacking supporting documentation for the services