A US federal watchdog has estimated that Tennessee claimed at least US$59.3 million in unallowable federal Medicaid reimbursement for targeted case management services during fiscal years 2021 to 2023.
The Department of Health and Human Services Office of Inspector General reviewed a sample of 150 grouped line items and found 43 were unallowable because the enrollees did not meet eligibility criteria in Tennessee’s state plan.
OIG recommended that Tennessee refund US$59.3 million and revise its procedures to verify eligibility before submitting claims for targeted case management services.
