DHSS Inspector General Recommends Illinois Repay Funds to CMS for Questioned HCBS Costs

During SFY 2005, the DHHS Office of Inspector General estimates the State agency claimed $136,568 ($68,284 Federal share) for HCBS that did not comply with Federal and State requirements and $1,454,144 ($727,072 Federal share) for services that may not have been allowable for Medicaid reimbursement. Of the 100 random beneficiary-months reviewed, the State agency claimed reimbursement for HCBS that

• were provided by Chicago ARC and were allowable for 44 beneficiary-months,
• were unallowable in 29 beneficiary-months because CARC did not provide the services or meet documentation requirements; and
• may have been unallowable in 27 beneficiary-months because the CARC’s HCBS documentation did not include necessary details to determine whether the services complied with Federal and State requirements.

The claims for the unallowable and potentially unallowable services were made because CARC did not implement adequate internal controls to ensure it documented and claimed reimbursement only for allowable services actually provided.

RECOMMENDATIONS

The OIG recommends that the State agency:

• refund $68,284 to the Federal Government for unallowable HCBS claimed in SFY 2005,
• work with CMS to resolve the $1,454,144 ($727,072 Federal share) for which documentation did not include necessary details to determine whether the services complied with Federal and State requirements, and
• require CARC to implement internal controls to ensure it documents and claims reimbursement only for allowable HCBS actually provided in accordance with Federal and State requirements.