Press Release  Audit Finds Newton Doctor Improperly Billed MassHealth for over $200,000, Including for Services Provided While He Traveled Abroad

Boston — Auditor Suzanne M. Bump today released an audit of the claims submitted to MassHealth by Dr. Hooshang Poor, a physician based in Newton Center. The audit found Dr. Poor improperly billed in excess of $200,000 during the audit period, including claims submitted for dates on which he was out of the country. Additionally, the audit found that his staff was writing prescriptions for medication despite not having met the requirements to do so.

The audit was conducted as part of a series conducted by Bump’s office focusing on providers of evaluation and management services. Using data analytics tools developed by Bump’s office, auditors were able to identify the providers submitting higher than average number of claims for evaluation and management services, indicating potential risk of improper billing procedures. The tools, which allow Bump’s staff to analyze multiple, large data sets to identify large-scale trends as well as outliers,  found that Dr. Poor submitted significantly more evaluation and management claims than his peers for residents residing in nursing facilities, which led to the completion of this audit.

“This audit raises serious concerns about the billing and prescription practices of Dr. Poor and his staff,” Bump said. “These practices are not only costing taxpayer dollars, but also could compromise the health and wellbeing of patients. MassHealth must work quickly to recoup the improper and excessive payments made to Dr. Poor, and ensure all future claims and activities of his office are in compliance with applicable laws and regulations.”

Bump’s audit found that Dr. Poor submitted $176,730 in excessive evaluation and management claims. Under MassHealth regulations, physicians can only bill MassHealth for one evaluation and management claim per member per month for patients in long-term-care facilities, unless there is a documented medical emergency. However, the audit notes that Dr. Poor submitted claims in excess of what these regulations allow in 2,272 instances that were not predicated on medical emergencies. The audit found that in one instance, Dr. Poor billed MassHealth for ten evaluation and management services to one member in a single month.  

Additionally, the audit found that Dr. Poor billed MassHealth for more than $15,000 in services that took place while he was traveling abroad. Bump’s staff found claims submitted to MassHealth while Dr. Poor was out of the country on ten different occasions.

The audit also found Dr. Poor used improper billing and modifier codes, and lacked documentation to support his claims, resulting in additional improper payments.

As a result of the findings, Bump has called on MassHealth to work with Dr. Poor to recoup improper and excessive payments made to him.

The audit also found that Dr. Poor did not establish proper guidelines for his staff to follow when prescribing medications to their patients. Despite this, Dr. Poor’s staff submitted applications and reauthorization forms for certification to write prescriptions indicating that these guidelines were in place. During the audit period, Dr. Poor’s nurse practitioner (NP) and physician’s assistant (PA) wrote 657 prescriptions, including 211 for narcotics such as fentanyl, oxycodone, and methadone. Bump called on Dr. Poor’s NP and PA to immediately cease writing prescriptions until such guidelines are in place.

Read the audit of claims submitted to MassHealth by Dr. Hooshang Poor here.

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