Overview
During this reporting period, the Office of the State Auditor (OSA) began or continued work on three audits of MassHealth’s administration of the Medicaid program and Medicaid service providers’ compliance with state and federal laws, regulations, and other authoritative guidance. These audits were selected based on OSA’s research and applied data analytics to identify areas of risk in the state’s Medicaid program. Based on preliminary analysis and previous audit results, we anticipate that these audits may continue to identify improper payments and areas for improvement 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. In addition, we intend to initiate new Medicaid audits aligned with Auditor DiZoglio’s social justice and equity audit plans. The following is a summary of our Medicaid audit work in process.
- OSA is working with the US Department of Health and Human Services Office of Inspector General (Boston office) on a review of improperly paid capitation payments[1] for MassHealth members with concurrent eligibility in another state for the period January 1, 2018 through September 30, 2021. OSA will determine whether MassHealth made capitation payments for Massachusetts Medicaid beneficiaries who lived and were enrolled in Medicaid in another state. As applicable, OSA will identify the reasons this occurred and make recommendations to resolve any issues.
- OSA will conduct a review of MassHealth’s telehealth services for adult foster care for the period January 1, 2020 through December 31, 2021. This audit will determine whether MassHealth ensures the program integrity of its telehealth services, in accordance with federal and state requirements.
- OSA will conduct a review of MassHealth’s telehealth services for adult day health for the period January 1, 2020 through December 31, 2021. This audit will determine whether MassHealth paid adult day health providers in accordance with its telehealth policies and state regulations. In addition, as part of this review OSA will work with the US Department of the Treasury on a review of capitation payments for MassHealth members who have been identified by the Department of the Treasury’s Do Not Pay service as being deceased. OSA will identify the reasons why this has occurred and make the appropriate recommendations to MassHealth to resolve any issues.
[1]. Capitation payments are set payments to a managed care organization from MassHealth to provide healthcare for its members. These payments are paid monthly for each MassHealth member enrolled in the managed care organization.
| Date published: | March 2, 2023 |
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