Press Release  Audit Finds More Than $16 Million in Potentially Fraudulent Billings from MassHealth Vendor

Boston — State Auditor Suzanne M. Bump today called for MassHealth to recover more than $16 million in potentially fraudulent charges made by a wheelchair-van provider that charged for members who did not need or did not use wheelchairs. MassHealth payments to Rite Way during 2013 and 2014 totaled almost nine times the payments made to the next highest paid provider.

“Rite Way could not produce the required medical authorization forms for a single one of its passengers, 95% of whom we found to be ambulatory,” said Auditor Bump. “Its explanation that MassHealth told it to bill in this way also could not be substantiated. Such an egregious abuse of MassHealth must be remedied.”

MassHealth, the state’s Medicaid agency, with an annual budget of $12.2 billion, provides healthcare services for approximately 1.5 million low-and-moderate income individuals. MassHealth is the state’s largest program and accounts for approximately one-third of the state budget. During the 24-month audit period, MassHealth paid approximately $39.5 million for wheelchair-van transportation for 49,745 members.

The audit found Rite Way submitted claims for:

• Wheelchair transportation for people who did not need wheelchair services, totaling over $16 million;
• Transporting members from their home to a medical appointment although records show the member was hospitalized; and
• Transporting members to a medical appointment when records show the member never went to the appointment.

In August, the OSA discussed these audit findings with the Attorney General’s office. Following this meeting, the AGO okayed MassHealth’s suspension of payments to Rite Way.

“I commend MassHealth for recognizing the potential issues raised by Rite Way’s activities and taking action,” said Auditor Bump. “That said, I encourage MassHealth to develop edits in its claims system that would prevent improper payments in the future.”

The Office of the State Auditor conducts performance audits of state government’s programs, departments, agencies, authorities, contracts, and vendors. With its reports, the OSA issues recommendations to improve accountability, efficiency, and transparency. The OSA has identified $1 billion in savings and potential recoveries for the Commonwealth since 2011 and auditees have implemented 95 percent of the OSA’s recommendations. Since 2011, the OSA has identified more than $624 million in unallowable, questionable, or potentially fraudulent spending and savings opportunities within MassHealth.

The audit of Rite Way LLC is available here.

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