Overview
During this reporting period, the Office of the State Auditor (OSA) began or continued work on four audits of MassHealth’s administration of the Medicaid program and of Medicaid service providers’ compliance with state and federal laws, regulations, and other authoritative guidance. These audits were selected based on our research and applied data analysis to identify areas of risk in the state’s Medicaid program. We anticipate that the audits will identify a significant number of improper payments as well as deficiencies in MassHealth’s administration of program services. When applicable, the audits will include recommendations to strengthen internal controls and oversight in MassHealth’s program administration. The following is a summary of our Medicaid audit work in process.
- OSA is working with the US Department of Health and Human Services and Office of Inspector General (Boston office) on a review of claims paid for members with both Medicaid and Medicare eligibility (referred to as dual-eligible members) for the period January 1, 2017 through December 31, 2018. We will determine whether MassHealth inappropriately paid for healthcare expenses for members, through Medicaid, that should have been covered by Medicare or hospice providers. As applicable, we will identify the reasons this occurred and make recommendations to resolve these problems.
- OSA is conducting a review of MassHealth’s real estate recovery efforts for the period July 1, 2016 through December 31, 2018. This audit will determine whether MassHealth properly seeks reimbursement for expenditures it has made on behalf of long-term-care recipients who have assets, typically real estate. We will determine whether MassHealth places liens on these assets and seeks reimbursement through probate upon members’ deaths in accordance with state regulations.
- OSA will conduct a review of MassHealth’s telehealth services for the period July 1, 2019 through June 30, 2021. This audit will determine whether MassHealth ensures the program integrity of its telehealth services, in accordance with federal and state requirements, after the rapid implementation necessitated by COVID-19.
- OSA will assess MassHealth’s oversight of the quality of services in nursing homes for the period July 1, 2019 through June 30, 2021. The specific areas of our review will include the reporting of abuse of elders, implementation of COVID-19 procedures, inspections and implementation of corrective measures, and provision of healthcare services (e.g., eye care or dental care).
| Date published: | March 11, 2021 |
|---|