Organization: | Office of the State Auditor |
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Date published: | June 8, 2018 |
Executive Summary
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 and Medicaid Services, within the US Department of Health and Human Services, administer the Medicare program and work with state governments to administer state Medicaid programs.
OSA has conducted an audit of orthodontic claims paid to Reen & Reen, DMD, P.C. (R&R), doing business as Reen & Willcutts Orthodontics, for the period July 1, 2012 through June 30, 2017. During this period, R&R was paid approximately $10,380,899 to provide orthodontic services to 6,887 MassHealth members. The purpose of the audit was to determine whether R&R properly billed MassHealth for orthodontic services and maintained documentation in members’ dental records to support these services.
The audit was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program. Several of our previously issued audit reports disclosed significant weaknesses in MassHealth’s claim-processing system that resulted in millions of dollars in potentially improper payments. As with any government program, public confidence is essential to the success and continued support of the state’s Medicaid program.
Below is a summary of our findings and recommendations, with links to each page listed.
R&R submitted bills using the wrong servicing provider identification number. |
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R&R improperly billed MassHealth when members had private insurance. |
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A PDF copy of the audit of Reen & Reen, DMD, P.C. is available here.
Abbreviations
CMR |
Code of Massachusetts Regulations |
EOB |
explanation of benefits |
HLD |
Handicapping Labio-Lingual Deviations |
MMIS |
Medicaid Management Information System |
OSA |
Office of the State Auditor |
R&R |
Reen & Reen, DMD, P.C. |
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Boston, MA 02133