Overview
In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor (OSA) has conducted a performance audit of certain activities of the Office of Medicaid (MassHealth) for the period January 1, 2018 through December 31, 2020.
We conducted this performance audit in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.
Below is our audit objective, indicating the question we intended our audit to answer, the conclusion we reached regarding the objective, and where the objective is discussed in this report.
Objective |
Conclusion |
Did MassHealth ensure that Delivery System Reform Incentive Payment (DSRIP) Program funding was allocated to accountable care organizations (ACOs) in accordance with Sections 3.3 and 3.4.4.1 of its Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M)? |
No; see Finding 1 |
To achieve our audit objective, we gained an understanding of the internal control environment related to the objective by reviewing applicable MassHealth policies and procedures and interviewing MassHealth officials who are responsible for oversight of the DSRIP Program. We evaluated the design and operating effectiveness of internal controls related to the ACO budget approval process. Specifically, we performed control testing to determine whether each ACO’s budget proposal was approved by the DSRIP Program’s independent assessor.
We performed the following procedures to obtain sufficient, appropriate audit evidence to address the audit objective.
We determined whether MassHealth ensured that DSRIP Program funding was allocated to ACOs in accordance with the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M). To do this, we verified that ACOs submitted DSRIP Program budgets in calendar years 2018, 2019, and 2020 (MassHealth provided these budgets to us as Excel spreadsheets) before the beginning of the budget period, which starts January 1 of each calendar year, as required by the protocol. We inspected the original emails ACOs had sent to MassHealth with the budgets attached to verify that each email date was before the beginning of the budget period. We then compared the dates of budget approvals by the independent assessor to the dates of quarterly funding disbursements, obtained from the Medicaid Management Information System (MMIS), to determine whether each ACO budget was approved before MassHealth disbursed funding. If an ACO revised its budget after the first quarter, we verified that the independent assessor approved the revised budget before MassHealth issued subsequent quarterly payments.
Data Reliability
We obtained DSRIP Program transaction data from MMIS for testing purposes. To test the reliability of the data, we relied on the work performed by OSA in a separate project, completed in 2018, that tested certain information system controls in MMIS. As part of that work, OSA reviewed existing information, tested selected system controls, and interviewed knowledgeable MassHealth officials about the data. As part of our current audit, we performed validity and integrity tests on all DSRIP Program transaction data, including (1) testing for blank fields, (2) scanning for duplicate records, (3) looking for dates outside the audit period, and (4) looking for duplicate check numbers. Additionally, to determine the completeness and accuracy of the data, we selected a random sample of 20 DSRIP Program transactions from MMIS and traced the dates of payment and total budgeted amounts to budget source documentation. We also sampled 20 DSRIP Program transactions from budget source documentation and vouched1 to MMIS. Based on these procedures, we determined that the data obtained were sufficiently reliable for the purposes of this report.
Date published: | June 29, 2022 |
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