BSI FY25 Year In Review

A summary of the activities of BSI in FY25.

Overview

Figure 1. Fraud Dollars Identified for FY25, by Public Benefit Program*

                                             Total Fraud Identified: $11,952,288

*  The numbers in this figure have been rounded down to the nearest dollar for presentation purposes.

BSI By the Numbers

535 Completed investigations with identified fraud

3,890 BSI cases at the start of FY25 

          +

4,513 new investigations

           -

4,179 completed investigations

          =

4,224 BSI cases at the start of FY26

Figure 2. Fraud Dollars Identified for FY25, by Referral Source*

                                          Total Fraud Identified: $11,952,287

*  The numbers in this figure have been rounded down to the nearest dollar for presentation purposes. The totals in Figures 1 and 2 do not match due to rounding.

Table 1. Cases for FY25, by Referral Source

Cases	BSI	EEC	DAU	MassHealth	DTA	BSI Hotline	Law Enforcement	PCA Task Force7	Task Force	Other	Total
Beginning Balance	5	4	355	223	2,597	577	3	48	59	19	3890
New Investigations	28	0	1,0098	26	2,152	1,200	0	78	20	0	4513
Total Completed Investigations	29	1	637	91	2,192	1,184	1	25	18	1	4179
Closed with No Fraud	4	1	333	75	720	937	0	25	7	0	2102
Closed with Identified Fraud	3	0	53	8	320	37	0	0	2	0	4239
Closed as Potential Intentional Program Violation	0	0	228	2	921	177	1	0	0	0	1329
Completed; Pending Court/Non-Court/Calculation10	22	0	23	6	231	33	0	0	9	1	32511

Closed Cases with Identified Fraud, by Disposition

BSI investigations may result in a referral for prosecution, a civil recovery, or a referral for further action. Cases referred for prosecution are those for which BSI files a criminal complaint against the subject(s) or refers the case to a district attorney’s office, the Attorney General’s Office, or the US Attorney’s Office.

All investigations completed and closed by BSI are considered closed cases, either with or without identified fraud. Closed cases are cases that have been adjudicated completely, for which BSI does not pursue any further action.

BSI uses different disposition codes to categorize closed cases with identified fraud. The various disposition codes are as follows:

• Cancellations are cases that are recommended for return to DTA because the preliminary investigation did not develop sufficient evidence to warrant further BSI investigation.¹²
• No Fraud Determinations are cases for which the allegation of fraud cannot be substantiated following an investigation.
• Intentional Program Violations (IPVs) are cases that are returned to DTA, MassHealth, or EEC to be handled by those agencies.
• Consolidations are cases that are merged with already-open BSI cases following an additional referral.
• Civil Recovery Cases are cases that are resolved through an agreement in which subjects agree to repay part or all of the fraudulently obtained benefits to the Commonwealth. Repayment terms must follow the originating agency’s rules and regulations.
• Administrative Closings are cases that are completed without an overpayment calculation due to various factors (e.g., the subject is deceased, the subject moved and BSI was unable to locate them, or BSI error).
• Guilty are cases with identified fraud that were referred for prosecution and for which the subject has either pleaded guilty or received a guilty verdict after a bench or jury trial.
• Nolle Prosequi are cases with identified fraud that were referred for prosecution and for which prosecution was declined by a district attorney after filing charges before a verdict was rendered.
• Refer for Further Action with Financials are cases with identified fraud that were referred for further action; the matter may be referred to the Office of the State Auditor for a potential audit or another state agency for further action.

During FY25, BSI closed 4,018 cases¹³ and categorized them under the following disposition codes.

Figure 3. Summary of Closed Cases during FY25, by Disposition Code

7. PCA refers to MassHealth overpayments for PCA services. Member healthcare benefit overpayments are referred to as Medicaid.
8. DUA generated 1,196 referrals in FY24, which CPU processed in BSI’s CMS in FY25. A total of 1,011 new allegations were created from these referrals, of which, 1,009 were opened as new investigations and 2 were merged with already existing investigations.
9. Of the 535 cases completed with identified fraud during FY25, 423 cases were closed with a final disposition that signify identified fraud.
10. Completed; Pending Court/Non-Court/Calculation cases include calculated cases that are pending court/non-court outcomes and cases that are pending fraud calculation(s) from the referral source(s).
11. This number indicates cases without a disposition or financial type (which is the calculated overpayment of a specific public benefit) because they are pending court/non-court/calculation as of this report’s drafting.
12. Pending DTA’s administrative process, these cases may be deemed intentional program violations or unintentional program violations.
13. This number of closed cases reflects the total number of cases BSI closed with a final disposition during FY25; BSI completed 4,179 investigations during FY25, some of which are still pending a fraud calculation or a final disposition as of this report’s drafting.

Date published:	January 30, 2026