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Press Release

Press Release Auditor Calls on Providers to Repay $215K as a Result of Improperly Billing MassHealth

The audits found that Northgate Medical P.C. of Springfield and Asaker Medical Associates of Brockton billed MassHealth for services that are more costly than the services that were actually provided.
For immediate release:
2/25/2016
  • Office of State Auditor Suzanne M. Bump

Media Contact for Auditor Calls on Providers to Repay $215K as a Result of Improperly Billing MassHealth

Mike Wessler, Communications Director

Doctor wearing lab coat and stethoscope

Boston — Auditor Suzanne M. Bump today released a pair of audits that call on two medical providers to repay $215,505 they were paid as a result of improperly billing MassHealth. The audits found that Northgate Medical P.C. of Springfield and Asaker Medical Associates of Brockton billed MassHealth for services that are more costly than the services that were actually provided.  

“The audits found that both Northgate and Asaker billed MassHealth as if services were provided by a doctor when in fact the services were provided by nurse practitioners and physician assistants, which are paid at a lower rate,” said Bump. “MassHealth makes up more than one-third of our annual state budget so it is crucial the funds are spent effectively and that the program operates with integrity.”

Bump’s office used advanced data analytics to analyze millions of MassHealth claims and identified that Northgate Medical billed for a number of high value services far exceeding the amount submitted by its peers. This analysis indicated that this facility may be participating in a practice known as upcoding, in which providers charge for services that are more expensive than what was provided.

In addition to the upcoding found at Northgate Medical, the audits found that both providers received overpayments from MassHealth for instances where a claim stated that treatment was provided by a physician, when it had actually been provided by a nurse practitioner or physician’s assistant.

The audits found that over a three-year period, Northgate improperly billed MassHealth for approximately $191,148 resulting from both of these improper billing strategies, and Asaker improperly billed MassHealth for approximately $24,357 for billing for physician-provided services that were actually performed by nurse practitioners.  

“Providing oversight to the MassHealth program is a role the Auditor’s Office takes very seriously,” said Bump. “Our ability to analyze data quickly and identify trends helps us notify MassHealth of potential weaknesses in its claims system and address problems in a timely manner. It is vitally important that MassHealth quickly address these issues to help control healthcare costs.”

In fiscal year 2015, MassHealth paid healthcare providers $13.6 billion. Massachusetts receives a reimbursement from the federal government for 50 percent of most services provided to MassHealth members. MassHealth expenditures account for roughly 38 percent of the state’s total annual budget.

The Northgate Medical P.C. audit is available here.
The Asaker Medical Associates audit is available here.

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Media Contact for Auditor Calls on Providers to Repay $215K as a Result of Improperly Billing MassHealth

Office of the State Auditor 

The Office of State Auditor Suzanne M. Bump (OSA) conducts audits, investigations, and studies to promote accountability and transparency, improve performance, and make government work better.
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