Audit  Audit of the Office of Medicaid (MassHealth)—Review of Vision Care Claims Paid to Dr. Khuong Nguyen

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 vision care claims paid to Dr. Khuong Nguyen for the period July 1, 2011 through December 31, 2016. During this period, MassHealth paid Dr. Nguyen $587,315 to provide vision care for 5,324 MassHealth members. The purpose of this audit was to determine whether these services provided to MassHealth members were properly supported by documentation and allowable in accordance with certain MassHealth regulations.

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, 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 findings and recommendations, with links to each page listed.

A PDF copy of the audit of the Office of Medicaid (MassHealth)—Review of Vision Care Claims Paid to Dr. Khuong Nguyen is available here.