Press Release  Audit Calls for Improvements at Norwood Adult Day Health Center

Boston — State Auditor Suzanne M. Bump today released an audit calling for improvements to the documentation of services billed to MassHealth by Norwood Adult Day Health Center (NADHC). MassHealth covers claims for ADH services for members who need assistance with activities of daily living such as eating, using the restroom, bathing, walking, and taking medication.

Bump’s audit determined that NADHC did not have proper physician order documentation for adult day health services that were provided to MassHealth members, totaling $92,644. MassHealth regulations require that a physician order must be obtained before a member receives health care services. The audit calls on NADHC to improve its documentation for future claims and to work with MassHealth to determine what amount should be repaid back to the state.

“Adult day health programs that serve the elderly and people with disabilities must be accurate in their documentation of services provided to ensure the correct form of care is reaching patients,” said Bump of the audit. “It is imperative that providers, such as Norwood Adult Day Health Center, have thorough documentation practices in place to maintain public trust in this important program. I commend MassHealth for taking these findings seriously.”

Additionally, the audit also found NADHC’s billing agent, HealthCare Options, Inc., used the wrong location for services provided to some MassHealth members. The audit notes that due to these inaccuracies, MassHealth could reject these claims, which would result in a loss of billing revenue.   

In fiscal year 2017, MassHealth paid healthcare providers $15.3 billion for services for approximately 1.9 million low-and-moderate income individuals. It is the state’s largest program and accounts for approximately thirty-nine percent of the state budget.

The audit is available here.

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