The objectives of the performance audits conducted by the Office of the State Auditor (OSA) at MassHealth and its providers are not only to identify improper payments for Medicaid services, but also to identify and resolve any systemic problems such as deficiencies in internal controls that may exist within the MassHealth system. Consequently, while measures such as referring cases to law enforcement for prosecution, recommending restitution, and taking other remedial actions against individual Medicaid vendors are typical results of OSA audits and serve as a deterrent, the systemic changes made by MassHealth as a result of OSA audits, in many instances, have a more significant effect on the overall efficiency of the operation of Medicaid-funded programs.
To assess the impact of our audits and the post-audit efforts made by auditees to address issues raised in our reports, OSA has implemented a post-audit review (PAR) survey process that is conducted six months after the release of an audit. This process documents the status of the recommendations made by OSA, including any corrective measures taken by the auditee as well as any estimates of future cost savings resulting from changes made based on our recommendations.
During the reporting period, OSA issued, and MassHealth completed, one PAR survey for Medicaid audits. This number reflects audits with findings issued at least six months ago for which follow-up surveys have been completed. The self-reported surveys are issued six months after an audit is issued to allow management time to plan and implement its corrective action/s. Because the voluntary surveys are sent to MassHealth six months after the audit ends, not all of the audits conducted from March 15, 2020 through March 12, 2021 are included in this section of the report, as those surveys have not been completed yet.
According to the survey results received, MassHealth and its providers reported that it has acted on implementing both recommendations. A summary of the audit survey follows.
1. Office of Medicaid (MassHealth)—Review of Estate Recovery
|
Audit No. |
2019-1374-3M4 |
|
Issue Date |
June 28, 2021 |
|
PAR Survey Date |
December 14, 2021 |
|
Total Recommendations |
2 |
|
Fully Implemented Recommendations |
2 |
|
Recommendations in Progress |
N/A |
|
Fiscal Benefit |
N/A |
The finding from the audit of MassHealth’s estate recovery process was that MassHealth’s estate recovery might cause some families undue financial hardship. Specifically, although MassHealth allows undue-hardship waivers, only a small number of members’ survivors actually petition for them and even fewer are approved. The resulting financial hardship could place a burden on families. Also, MassHealth pursues estate recovery amounts below $25,000, which may not be cost effective.
In its PAR survey, MassHealth stated that it had fully implemented our recommendations.