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

Our objective was to determine whether the Georgia Department of Community Health (the Medicaid agency) claimed costs for targeted case management (TCM) services for individuals deemed at risk of incarceration, in compliance with Federal and State requirements.  Based on our sample results, we estimate that during Federal fiscal years (FY) 2003 and 2004, the Medicaid agency claimed $4,654,984 ($2,835,507 Federal share) in TCM costs for services not in compliance with Federal and State requirements.  The Medicaid agency inappropriately claimed Federal financial participation (FFP) for unallowable services provided by the Georgia Department of Juvenile Justice (DJJ) because neither the Medicaid agency nor DJJ had adequate controls to ensure that the services claimed were eligible for FFP.

We recommended that the Medicaid agency refund to the Federal Government the $2,835,507 estimated overpayment for Federal FYs 2003 and 2004, examine claims made during the period subsequent to our audit for compliance with these requirements and refund any overpayments identified, and establish monitoring procedures to provide reasonable assurance that DJJ complies with Federal and State requirements in submitting TCM claims.  The Medicaid agency stated that it would refund the Federal share once a final determination has been made as to the overpayment for Federal FYs 2003 and 2004 and that it would comply with our second and third recommendations.