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October 15, 2007
 Review of Minnesota Medicaid Reimbursement for Targeted Case Management
Services for Fiscal Years 2003 & 2004
An audit of 2003 and 2004 targeted case management (TCM) claims submitted
by the Minnesota Department of Human Services (DHS) found that some
claims lacked sufficient detail about the services provided such that it
was not possible to determine if a qualified service was provided. The
claims did not comply with federal or state law; for example, the state
provider manual specifies that case records for child welfare TCM need to
include the who, what, when, and why of the contact. Of 118 claims
filed in 100 beneficiary-months, 7 claims included in 7 months lacked
full documentation. During the time period under review DHS claimed
$346.6 million for TCM services; of that, the federal government said
that $3.7 million should be refunded.
The federal Office of the Inspector General for the Department of Health
and Human Services selected a random sample of 100 beneficiary-months
with 118 TCM claims submitted by the State agency for Medicaid-eligible
beneficiaries. A beneficiary-month includes all TCM services for a
beneficiary for 1 month. The beneficiary-month can include multiple
claims from the same or different providers. OIG then extrapolated the
findings to all claims filed during the period under review.
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OPEN MINDS