Press Release  Audit Calls for Improvements to MassHealth Billing Practices of United Cerebral Palsy of MetroBoston

Boston — State Auditor Suzanne M. Bump released an audit today of MassHealth claims submitted by United Cerebral Palsy of MetroBoston (UCP). The audit calls on UCP to take steps to ensure it receives required medical provider authorizations before providing day habilitation (DH) services to MassHealth members. She also calls on the provider to work with MassHealth to repay improper payments.

UCP is one of approximately 128 providers of DH services in the Commonwealth. During the audit period (April 1, 2015 through July 31, 2018), it provided DH services to 111 MassHealth members and received payments of $4,505,326 for these services. Bump’s office found UCP provided these services to six members without first obtaining authorization from their physician or primary care clinician. MassHealth regulations require DH providers to secure these authorizations before providing services. UCP received a total of $122,357 for DH services provided to these members during the audit period. 

“United Cerebral Palsy of MetroBoston provides important services to people with developmental disabilities, but failure to receive proper authorizations before providing these services reduces public trust in its billing practices. I encourage UCP to work with MassHealth to address the billing deficiencies we identified and make any necessary repayments to the Commonwealth,” Bump said.

Day habilitation services help people with developmental disabilities improve their independent functioning and assist them with activities of daily living.

MassHealth is administered through the Executive Office of Health and Human Services, through the Division of Medical Assistance. The state’s Medicaid program annually provides access to health care for approximately 1.9 million eligible low- and moderate-income children, families, seniors, and people with disabilities. In FY17, MassHealth paid providers more than $15 billion, of which 50 percent was funded by the Commonwealth. Medicaid expenditures represent approximately 39 percent of the state’s total annual budget.

The full audit report is available here.

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