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State audits identified $17.6 million in improper MassHealth payments in a year

Massachusetts Auditor Suzanne Bump's office identified $17.6 million in questionable or potentially fraudulent MassHealth payments between March 2016 and March 2017, according to an annual report released Wednesday.

 

 "The MassHealth program is large, complex, and expensive," Bump said in a statement. "It is also too susceptible to improper payments to providers.... There are far too many provider bills that get paid despite the fact they are duplicative of other payments, lack supporting documentation, or violate regulations governing what is and what is not reimbursable."

Many of the findings laid out in the annual report have been made public in previous audits. The annual report offers a snapshot of a year's worth of 11 audits of MassHealth.

Some of the issues Bump's office identified include payments to providers who were prohibited from participating in MassHealth due to federal laws; duplicate payments to individuals who were getting paid by two different state programs; and payments to specific dental providers who provided services in a way that was not consistent with MassHealth regulations.

Bump's office is also in the process of completing an additional 13 audits related to MassHealth. It is examining whether patients covered by both Medicare and Medicaid were improperly paid for entirely by Medicaid, costing the state federal reimbursement money. It is auditing payments to specific hospice providers, optometrists and doctors where initial data analysis found potential problems, such as billing MassHealth for an unusually large number of patients on one day.

Auditors are also reviewing payments for urine drug screenings. A 2012 audit identified urine drug screenings as an area where MassHealth improperly paid out millions of dollars, but Bump's office found MassHealth still has not made improvements recommended by that audit, which could avoid some of these payments.

The amount of improper payments is still small compared to the size of the MassHealth, which covered $14.8 billion worth of health care benefits for 1.9 people in fiscal 2016, with a mix of state and federal money.

MassHealth can use the audits to recover money that was paid improperly. Bump's report writes that MassHealth is acting on most of the recommendations made in the audits.

MassHealth anticipates saving an estimated $8.6 million annually after terminating a contract with a medical transportation provider, Rite Way, whose owners have been indicated for Medicaid fraud.

Resource: http://www.masslive.com/