Overview
During this reporting period, the Office of the State Auditor (OSA) began or continued work on six 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 are using y 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 will continue to identify improper payments and areas for improvement in MassHealth’s administration of program services. Where 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 conducting 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 is conducting 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 as deceased by the US Department of the Treasury’s Do Not Pay service. OSA will identify the reasons this occurred and make the appropriate recommendations to MassHealth to resolve any issues.
- OSA is conducting a review of MassHealth claims submitted by Dental Arts for the period July 1, 2019 through June 30, 2023. This audit will determine whether dental services provided to MassHealth members were properly supported by documentation and were allowable in accordance with certain MassHealth regulations.
- OSA is conducting a review of MassHealth claims submitted for non-emergency transportation for the period July 1, 2020 through June 30, 2023. This audit will determine whether MassHealth’s non-emergency transportation broker process provides equal opportunity to contracted providers throughout the Commonwealth, whether non-emergency transportation claims were properly authorized, and whether transportation drivers and attendants consistently have a Criminal Offender Record Information check.
- OSA is working with the US Department of Health and Human Services Office of Inspector General (Boston office) to review improperly paid capitation payments for MassHealth members with multiple Medicaid identification numbers for the period January 1, 2019 through December 31, 2022. OSA will determine whether MassHealth made capitation payments for Massachusetts Medicaid beneficiaries with multiple MassHealth member identification numbers. As applicable, OSA will identify the reasons this occurred and make recommendations to resolve any issues.
- OSA is conducting a review of MassHealth claims submitted by University of Massachusetts Memorial Healthcare (UMMH) for inpatient maternity care during the period July 1, 2020 through June 30, 2023. This audit will determine whether claims were submitted to MassHealth in accordance with its regulations and whether UMMH appropriately used state allocated funds. This audit will also examine UMMH’s system for tracking and reporting births to the Department of Public Health.
| Date published: | March 1, 2024 |
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