| Organization: | Office of the State Auditor |
|---|---|
| Date published: | May 8, 2025 |
Executive Summary
The Office of the State Auditor 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, administers the Medicare program and works with state governments to administer state Medicaid programs.
The Office of the State Auditor has conducted an audit of payments made by MassHealth for nonemergency transportation services for the period July 1, 2020 through June 30, 2023. During this period, MassHealth made approximately $283.3 million in total payments to its two brokers, which were the Montachusett Regional Transit Authority (MART) and the Greater Attleboro Taunton Regional Transit Authority (GATRA). These brokers were responsible for arranging rides for MassHealth members to receive nonemergency services on a cost-savings basis. The purpose of this audit was to determine whether MassHealth ensured that its broker process provides equal opportunity to contracted transportation providers, whether transportation services were properly authorized and documented in accordance with Sections 407.421(D) and 450.205(A) of Title 130 of the Code of Massachusetts Regulations (CMR), and whether Criminal Offender Record Information checks were consistently completed and documented for transportation drivers in accordance with 130 CMR 407.405(B). The Office of the State Auditor conducted the audit as part of our ongoing independent statutory oversight of the state’s Medicaid program.
Below is a summary of our findings, the effects of those findings, and our recommendations, with links to each page listed.
| Finding 1 | MassHealth paid for nonemergency transportation services when there was no qualifying medical service on the same day. |
| Effect | We extrapolated the test results related to the four unallowable nonemergency transportation claims to the entire population and estimate that MassHealth overpaid at least $1,669,323 for nonemergency transportation services. Consequently, the claims submitted for these nonemergency transportation services represent unallowable costs to the Commonwealth. |
| Recommendation | MassHealth should ensure that brokers maintain documentation for all transportation services provided to MassHealth members. |
| Finding 2 | MassHealth paid for nonemergency transportation services that were not properly documented. |
| Effect | Without sufficient evidence of trips, MassHealth may be paying for transportation services that did not take place. |
| Recommendations |
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