Audit  Audit of the Office of Medicaid (MassHealth)—Massachusetts Delivery System Reform Incentive Payment Program

The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the Commonwealth’s Medicaid program. This program, known as MassHealth, is administered under Chapter 118E of the Massachusetts General Laws by the Executive Office of Health and Human Services, through the Division of Medical Assistance. Medicaid is a joint federal-state program created by Congress in 1965 as Title XIX of the Social Security Act. At the federal level, the Centers for Medicare & Medicaid Services, within the United States Department of Health and Human Services, regulate Medicaid services and work with state governments to administer their Medicaid programs.

OSA has conducted an audit of certain payments made by MassHealth under the Delivery System Reform Incentive Payment (DSRIP) Program for the period January 1, 2018 through December 31, 2020. During this period, MassHealth transitioned to the accountable care organization (ACO) care model, which ensures that healthcare organizations in each ACO’s network are responsible for the quality, experience, and cost of healthcare for MassHealth members. To do this, MassHealth disbursed approximately $500,176,599 to its ACOs.

The purpose of this audit was to determine whether MassHealth effectively administered DSRIP Program payments to ACOs in accordance with its Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M). OSA conducted the audit as part of our ongoing independent statutory oversight of the state’s Medicaid program.

Below is a summary of our finding and our recommendation, with links to each page listed.

A PDF copy of the Audit of the Office of Medicaid - Massachusetts Delivery System Reform Incentive Payment Program is available here.