Press Release  Auditor Bump Calls on Carlisle Optometrist to Repay Over $300,000 to MassHealth

Boston — In an audit released today, State Auditor Suzanne M. Bump calls on Dr. Frederick Wagner Jr., an optometrist in Carlisle, to reimburse the MassHealth program for $310,112 in claims he submitted that lacked adequate documentation or were otherwise improper. The audit, which was initiated after MassHealth found similar problems with the billing practices of this provider, examined the period of January 1, 2014 through December 31, 2017.

Among several improper activities were the submission of bills that lacked documentation for the services provided and numerous instances where billing dates did not match those in the members’ medical records, and many bills for eyeglass dispensing and fitting services. The audit found 226 occasions that the optometrist received payment from MassHealth for dispensing services and associated transportation, despite no eyeglasses being ordered from the optical supplier.

“I have concerns that some of Dr. Wagner’s patients, many of whom are individuals with Alzheimer’s disease, dementia, and other similar conditions, may not have been able to properly consent to the procedures provided, resulting in these improper payments,” Bump said of the audit.

The audit also questions the wisdom of a MassHealth regulation that allows providers to bill for non-emergency transportation services for each member seen at a nursing facility, even if multiple patients are seen at the same facility on the same day. The audit points to a single day in which Dr. Wagner was paid for 27 travel claims, but visited only two nursing facilities. The audit notes that if MassHealth required optometrists to bill the program for transportation by each facility visited, rather than by each member seen, it would have reduced the non-emergency travel payments to Dr. Wagner during the audit period from $131,020 to $12,807, saving $118,213.

“The current policies of MassHealth regarding transportation claims defy logic and are ripe for abuse,” Bump said. “MassHealth must revise this policy and implement protocols to ensure physicians cannot bill the program multiple times for a single trip.”

Dr. Wagner is an optometrist and sole business proprietor who lists his home as his office. He is a certified MassHealth provider who travels to nursing facilities across the state. During the audit period, MassHealth paid him approximately $1,045,556 to provide vision care services for 3,741 members.

MassHealth is administered by the Executive Office of Health and Human Services, through the Division of Medical Assistance. The state’s Medicaid program annually provides access to healthcare 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 report is available here.

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