Press Release  Audit Finds MassHealth made payments totaling $91,852,881 to its providers for services that were not properly documented

Boston — In an audit released today, State Auditor Suzanne M. Bump found that during the period January 1, 2020 through June 30, 2021, MassHealth made payments totaling $91,852,881 to providers for telehealth behavioral health services that did not have proper documentation. MassHealth has issued what it calls, All Provider Bulletins, and payments were made early in the COVID pandemic, when most providers were unfamiliar with the procedures for telehealth billing. Nonetheless, the findings were stark. A statistical sample of 47 claims were reviewed and for all 47 claims, providers were unable to provide documentation to substantiate that all required procedures were performed. The lack of documentation calls into question whether all the $91,852,881 in services were properly delivered.

“A year prior to the pandemic, MassHealth had begun allowing telehealth delivery of behavioral health services, but full procedural guidance had not been developed, and telehealth was used sparsely,” explained Auditor Bump. “The pandemic caught both MassHealth and the provider community off guard and compliance with the multiple bulletins issued to providers was spotty, making it impossible to determine with reasonable certainty that services were appropriately provided and billed. I am hopeful that after reviewing our analysis and recommendation MassHealth will make necessary changes to update record keeping requirements as outlined.”

Under Chapter 118E of the Massachusetts General Laws, the Executive Office of Health and Human Services, through the Division of Medical Assistance, administers the state’s Medicaid program, known as MassHealth. MassHealth provides access to healthcare for approximately 1.8 million low- and moderate-income children, families, seniors, and people with disabilities annually. In fiscal year 2021, MassHealth paid healthcare providers more than $18.1 billion, of which approximately 45% was funded by the Commonwealth. Medicaid expenditures represented approximately 40% of the Commonwealth’s total fiscal year 2021 budget.

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