Audit  Audit of the Office of Medicaid (MassHealth)—Review of Telehealth

The audit found MassHealth made payments totaling at least $91,852,881 to its providers for telehealth behavioral health services that were not properly documented. The audit reviewed the period of January 1, 2020 through June 30, 2021.

Organization: Office of the State Auditor
Date published: November 23, 2022

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 & Medicaid Services, within the United States Department of Health and Human Services, administer the Medicare program and work with state governments to administer state Medicaid programs.

OSA has conducted a performance audit of MassHealth’s payments for telehealth1 behavioral health services for the period January 1, 2020 through June 30, 2021. During this period, MassHealth paid approximately $96,464,816, for 1,306,414 claims, to its providers for telehealth behavioral health services to MassHealth members. The purpose of this audit was to determine whether MassHealth monitored telehealth practices for behavioral health services to ensure compliance with its All Provider Bulletins 281, 289, 291, 298, 303, and 314.

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 weaknesses in MassHealth’s claim processing system and improper billing practices by MassHealth providers, which 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 finding and recommendation, with links to each page listed.

Finding 1
 

MassHealth made payments totaling at least $91,852,881 to its providers for telehealth behavioral health services that were not properly documented.

Recommendation
 

MassHealth should train its providers, and establish monitoring controls, to ensure that telehealth services are documented in accordance with its All Provider Bulletins.

 

A PDF Copy of the Audit of the Office of Medicaid (MassHealth) - Review of Telehealth is availabl here.

 

1.    Telehealth allows patients to receive certain services without meeting with their providers in person. It can be provided via telephone or video call software. It can reduce travel costs, disruption of patients’ schedules, and potential spread of bacteria and other contagions.

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