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MassHealth Audits

Audits of the MassHealth program and provider billing.

MassHealth is a critically important program that provides millions of Massachusetts residents with access to health care, and accounts for nearly 40 percent of the state budget. This is why State Auditor Suzanne M. Bump has an audit unit dedicated exclusively to auditing this program and participating providers. These audits provide valuable recommendations that can result in significant savings and improve program performance.

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Table of Contents

2021

Annual Report Medicaid Audit Unit for March 15, 2020 through March 12, 2021  

2020

Audit of the Office of Medicaid (MassHealth)—A Review of MassHealth Member Eligibility at the Tewksbury Enrollment Center  
Audit of the Office of Medicaid (MassHealth)—A Review of MassHealth Member Eligibility at the Chelsea Enrollment Center  
Audit of the Office of Medicaid (MassHealth)—A Review of MassHealth Member Eligibility at the Taunton Enrollment Center  
Audit of the Office of Medicaid (MassHealth)—A Review of MassHealth Member Eligibility at the Springfield Enrollment Center  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services by Beyond Healthcare Agency, LLC  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services by City Home Care, LLC  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services by WestMass ElderCare, Inc.  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services by Boston Senior Home Care (BSHC)  
Audit of the Office of Medicaid (MassHealth) – Review of Claims Paid for Services by Old Colony Elder Services (OCES)  
Audit of the Office of Medicaid (MassHealth) - Review of Claims Paid for Services by Somerville-Cambridge Elder Services (SCES)  
Annual Report Medicaid Audit Unit for March 15, 2019 through March 14, 2020  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Submitted by Dr. Joseph O’Connor  

2019

Audit of the Office of Medicaid (MassHealth)—Review of Accounts Receivable  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Submitted by Dr. Frederick Wagner Jr.  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Day Habilitation Services Provided by United Cerebral Palsy (UCP)  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Pharmacy Drugs  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services Provided by Norwood Adult Day Health Center  
Audit of the Office of Medicaid (MassHealth)—Review of Counseling Provided to MassHealth Members Receiving Medication-Assisted Treatment for Opioid Use Disorders  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services Provided by Cozy Corner Adult Day Health  
Audit of the Office of Medicaid (MassHealth)—Review of Claims Paid for Services Provided by Liberty Adult Day Health  
Annual Report Medicaid Audit Unit for March 15, 2018-March 15, 2019  

2018

Audit of the Office of Medicaid (MassHealth)—Review of Claims Submitted by Dr. Ileana Berman  

Audit of Office of Medicaid (MassHealth)—Review of Drug Testing Frequency  

Audit of the Office of Medicaid (MassHealth)—Review of Vision Care Claims Paid to Dr. Khuong Nguyen  

Audit of the Office of Medicaid (MassHealth)—Review of Claims by Reen & Reen, DMD, P.C.  

Audit of the Office of Medicaid (MassHealth)—Review of Claims for Drug Test and Screen Services  

Annual Report Medicaid Audit Unit for March 15, 2017-March 14, 2018  

2017

Office of Medicaid (MassHealth)—Review of Vision Care Claims Paid to Dr. Wensheng Yao (PDF 957.56 KB)

Office of Medicaid (MassHealth) - Review of Hospice Care Billing: Good Shepherd Community Care (PDF 687.33 KB)

Office of Medicaid (MassHealth) - Review of Hospice Care Billing: HopeHealth Massachusetts, Inc. (PDF 594.3 KB)

Office of Medicaid (MassHealth)—Review of Evaluation and Management Claims Submitted by Dr. Hooshang D. Poor (PDF 876.96 KB)

Office of Medicaid (MassHealth)—Review of Evaluation and Management Claims Paid to Lawrence Family Doctors (PDF 756.17 KB)

SafetyNet Solutions (PDF 697.19 KB)

Community Connection Healthcare, LLC (PDF 710.32 KB)

Office of Medicaid (MassHealth)—Review of Payments for Nursing-Facility Claims (PDF 767.03 KB)

Office of Medicaid (MassHealth)—Review of Evaluation and Management Claims Paid to Resil Medical Associates, P.C. (PDF 795.28 KB)

Nizhoni Community Care LLC (PDF 700.4 KB)

Office of Medicaid (MassHealth)—Review of Claims for Durable Medical Equipment (PDF 752.92 KB)

Medical Community Services, Inc. (PDF 688.48 KB)

Office of Medicaid (MassHealth)—Review of Fee-for-Service Payments for Services Covered by the Massachusetts Behavioral Health Partnership (PDF 861.86 KB)

Office of the State Auditor—Annual Report Medicaid Audit Unit (PDF 621.68 KB)

Office of Medicaid (MassHealth)—Review of Dental Periapical Radiograph Claims Submitted by Dr. Najmeh Rashidfarokhi (PDF 739.36 KB)

Office of Medicaid (MassHealth)—Review of Dental Periapical Radiograph Claims Submitted by Webster Square Dental Care (PDF 752.24 KB)

Office of Medicaid (MassHealth)—Review of Dental Periapical Radiograph Claims Submitted by Our Dentist (PDF 718.74 KB)

Office of Medicaid (MassHealth)—Review of Dental Periapical Radiograph Claims Submitted by Sawan & Sawan, DMD (PDF 741.63 KB)

2016

Office of the State Auditor--Annual Report Medicaid Audit Unit (PDF 801.65 KB)

Office of Medicaid (MassHealth) - Review of Paid Claims within MassHealth's Adult Foster Care and Group Adult Foster Care Programs (PDF 1.13 MB)

Office of Medicaid (MassHealth) Review of Dental Periapical Radiograph Claims Submitted by Hampshire Family Dental and Orchard Family Dental (PDF 745.57 KB)

Office of Medicaid (MassHealth)-Review of Selected Outpatient Evaluation and Management Services Claims Submitted by Dr. Kunwar S. Singh (PDF 854.34 KB)

Office of Medicaid (MassHealth) Review of Providers Excluded from Participating in the Medicaid Program (PDF 704.87 KB)

Office of Medicaid (MassHealth)-Review of Claims Submitted by Hudson Home Health Care, Inc. (PDF 833.38 KB)

Office of Medicaid (MassHealth) Review of Evaluation and Management Claims Submitted by Asaker Medical Associates (PDF 1.02 MB)

Office of Medicaid (MassHealth) Review of Evaluation and Management Claims Submitted by Northgate Medical P.C. (PDF 903.6 KB)

Office of Medicaid (MassHealth)-Review of MassHealth's Progress to Implement Alternative Payment Methodologies (PDF 861.3 KB)

Office of Medicaid (MassHealth)-Review of Wheelchair Van Services Claims Submitted by Cataldo Ambulance Service (PDF 765.46 KB)

2015

Office of the State Auditor - Annual Report Medicaid Audit Unit (PDF 224.54 KB)

Office of Medicaid (MassHealth) Claims for Wheelchair-Van Services Submitted (PDF 709.62 KB)

Office of Medicaid (MassHealth) Review of Controls over Mobility-Assistive Equipment (PDF 538.32 KB)

Office of Medicaid (MassHealth) - Review of Radiology Claims Submitted by Baystate Mary Lane Hospital (PDF 180.58 KB)

Office of Medicaid Managed Care Organization (PDF 420.4 KB)

Office of Medicaid (MassHealth) Review of Non-Emergency Ambulance Transportation (PDF 291 KB)

Office of Medicaid (MassHealth) Review of Personal Care Attendant Services (PDF 436.99 KB)

An Examination of State Policies and Practices Regarding Medicaid Coverage for Inmate Inpatient Healthcare Costs (PDF 2.02 MB)

2014

Office of the State Auditor-Annual Report Medicaid Audit Unit (PDF 410.13 KB)

Office of Medicaid (MassHealth) Review of the MassHealth Limited Program (Emergency Medical Services) (PDF 827.64 KB)

2013

Office of the State Auditor-Annual Report Medicaid Audit Unit (PDF 244.38 KB)

Dr. Shahrzad Haghayegh / Hancock Dental PC (PDF 446.87 KB)

Office of Medicaid (MassHealth) Review of Controls over Pharmacy Claims (PDF 296.37 KB)

Office of Medicaid (MassHealth) Medicaid Claims for Drug Screenings (PDF 889.24 KB)

Office of Medicaid (MassHealth) Review of Controls over Dentist Billings for Detailed Oral Screenings and Other Dental Procedures (PDF 406.76 KB)

2012

MassHealth's Eligibility Determination Process for Healthcare Services (PDF 584.05 KB)

Internal Controls Established by EOHHS and MassHealth over Selected Information System Applications (PDF 194.6 KB)

2011

SmileCenter (PDF 629.27 KB)

Review of Claims Submitted for MassHealth by the Office of Dr. Melvin M. Frankel, DMD (PDF 407.37 KB)

Review of Claims Submitted to MassHealth by the Office of Dr. Doreen Chong, DDS (PDF 365.37 KB)

2010

MassHealth's Administration of Dental Claims (PDF 415.86 KB)
MassHealth's Administration of the Home Health Services Program (PDF 234.31 KB)
MassHealth's Management of Advanced Imaging Procedures (PDF 397.93 KB)
MassHealth Dental Program - Community Dentists (PDF 124.77 KB)
MassHealth Dental Program - Dr Randall L. Davis, DMD (PDF 124.52 KB)
MassHealth Dental Program - Holyoke Mall Dental Health Center (PDF 125.2 KB)
MassHealth Dental Program - John P. Burke, DMD (PDF 125.55 KB)
MassHealth Dental Program - Kool Smiles (Cambridge) (PDF 125.41 KB)
MassHealth Dental Program - Kool Smiles (Chelsea) (PDF 125.26 KB)
MassHealth Dental Program - Kool Smiles (New Bedford) (PDF 125.28 KB)
MassHealth Dental Program - Small Smiles Dental Clinic of Lawrence (PDF 124.95 KB)
MassHealth Dental Program - Small Smiles Dental Clinic of Springfield (PDF 125.16 KB)
MassHealth Dental Program - Small Smiles Dental Clinic of Worcester (PDF 125.12 KB)

2009

MassHealth's Payment of Certain Claims for Personal Care Services (PDF 412.79 KB)

2008

MassHealth's Administration of the Medicaid Drug Rebate Program (PDF 258.31 KB)
MassHealth's Internal Control Plan (PDF 239.72 KB)
MassHealth's Payment of Certain Claims for Personal Care Services (PDF 160.75 KB)
MassHealth's Payment of Durable Medical Equipment and Medical/Surgical Supply Claims (PDF 292.39 KB)

2006

Oversight of Fee for Service Transportation Provider Enrollment and Credentialing Process in the Medicaid Program (PDF 202.15 KB)

2005

Division of Medical Assistance (DMA) - Medicaid Administration (PDF 419.07 KB)
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