Overview
During this reporting period, the Office of the State Auditor (OSA) began or continued work on seven 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 we are using 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 claims submitted by providers for durable medical equipment (DME) for the audit period July 1, 2021 through June 30, 2023. This audit will determine whether DME was ordered or prescribed to members by providers who are excluded from participating in the Medicaid program and whether MassHealth paid for DME prescribed to members who are deceased.
- 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 had Criminal Offender Record Information checks.
- OSA is conducting a review of MassHealth reimbursements for inpatient maternity services provided by University of Massachusetts Memorial Healthcare (UMMH) during the period July 1, 2020 through June 30, 2023. This audit will determine whether UMMH properly billed MassHealth for maternity care for its members, whether UMMH reported births occurring in its hospitals to the Department of Public Health, and whether UMMH properly used grant funds from EOHHS and the Massachusetts Emergency Management Agency.
| Date published: | February 7, 2025 |
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