Overview
During this reporting period, the Office of the State Auditor began or continued work on 12 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 they will have a significant amount of improper payments related to identified deficiencies in MassHealth’s provision of program services and 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.
- A review, conducted with the Office of Inspector General within the United States Department of Health and Human Services (Boston office), of claims paid for members with both Medicaid and Medicare eligibility (referred to as dual eligible members) during the period January 1, 2017 through December 31, 2018. We will determine whether MassHealth inappropriately paid for member healthcare expenses through Medicaid that should have been covered by Medicare.
- A review of six MassHealth service providers for the period January 1, 2017 through December 31, 2018 to see whether they submit bills for duplicative services (for example, adult foster care and home health aide services for the same members on the same days).
- A review of MassHealth’s real estate recovery efforts during the period July 1, 2016 through December 31, 2018. This audit will determine whether MassHealth properly seeks reimbursement for expenditures it makes 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.
- Four separate audits of MassHealth’s enrollment centers (in Tewksbury, Chelsea, Springfield, and Taunton) for the period July 1, 2017 through December 31, 2018. We will determine whether the offices have effectively evaluated new applicants in accordance with certain MassHealth eligibility requirements.
| Date published: | March 13, 2020 |
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