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 the administration and delivery of program services. If applicable, these 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 reimbursed for clinical laboratory services for the audit period January 1, 2019 through December 31, 2023. The purpose of this audit is to determine whether MassHealth claimed reimbursement from the Federal government for outpatient clinical diagnostic laboratory services in accordance with applicable payment limits and in accordance with the Centers for Medicare & Medicaid Services’ State Medicaid Manual and Medicare Claims Processing Manual.
- OSA is conducting a review of MassHealth claims submitted by Bass River Inc. for the period July 1, 2023 through June 30, 2025. The purpose of this audit is to determine whether Bass River Inc. completed service needs assessments for MassHealth members, whether it obtained prior authorizations for MassHealth members attending day habilitation, and whether it billed MassHealth for services at the payment level authorized by MassHealth in accordance with certain MassHealth regulations.
- OSA is conducting a review of MassHealth claims for which antipsychotic medications were administered in nursing homes to determine whether appropriate monitoring and review occurred for the period July 1, 2023 through June 30, 2025. The purpose of this audit is to determine (1) how MassHealth monitored and reviewed the use of antipsychotic medications in nursing homes under its jurisdiction; (2) how it ensured that the administration of antipsychotic medications for nursing home patients had proper documentation, consent, and prior authorizations required by certain regulations; and (3) how it ensured that the appropriate staff members were trained and licensed to administer antipsychotic medications to patients in their care.
- OSA is conducting a review of EOHHS for the period July 1, 2023 through June 30, 2025. The purpose of this audit is to determine how EOHHS has integrated the information in its 2022 Report of the Special Commission on Racial Inequities in Maternal Health and DPH’s 2023 Review of Maternal Health Services reports to assess program effectiveness and internal division performance that rectifies healthcare inequities and better allocates funds, resources,and needed support for Commonwealth members experiencing maternal and perinatal healthcare needs.
| Date published: | February 25, 2026 |
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