Office of the State Auditor
13 indexed reports
Review of Durable Medical Equipment Providers
MassHealth did not fully ensure that DME was not ordered by excluded providers or for deceased members, as evidenced by three identified findings and associated overpayments; ongoing post-payment and ...
Performance Audit Report July 2025 Medicaid Provider Enrollment Follow-Up Audit
The Division of Health Benefits did not fully implement prior audit recommendations during 2023, leaving ongoing risks to patient safety and Medicaid integrity from providers with suspended licenses, ...
Office of Medicaid—Review of Capitation Payments With Multiple Identification Numbers
MassHealth did not ensure that capitation payments were not made on behalf of Medicaid beneficiaries who were assigned multiple IDs.
Estate Recovery Audit Report
The division had adequate controls to ensure compliance with federal and state regulations and general information system controls were in place and functioning. However, outdated policies and procedu...
Evaluation Of The Colorado Recovery Audit Contractor Program
HCPF’s Medicaid Recovery Audit Contractor program generally adheres to federal and state requirements but requires stronger contract oversight and program management to ensure efficient operation, red...
Medicaid Audit Unit—Annual Report
The audit identified an estimated $84,832,094 in capitation payments to MassHealth members residing outside Massachusetts. MassHealth has reported actions or planned actions on all four audit recommen...
Medicaid Correspondence Performance Audit
The audit concluded that the Department of Health Care Policy & Financing’s Medicaid correspondence exhibits significant clarity, accuracy, and completeness problems across CBMS and non-CBMS letters, ...
Office of Medicaid (MassHealth) — Review of Capitation Payments
MassHealth did not ensure that it does not make capitation payments to MCOs on behalf of ineligible members who reside outside Massachusetts; the State Auditor identified approximately $84.8 million i...
MassHealth Telehealth Review
MassHealth did not monitor telehealth practices to ensure compliance with its All Provider Bulletins for telehealth encounters, leading to at least $91,852,881 in potentially improper payments.
Office Of Medicaid (MassHealth)—Massachusetts Delivery System Reform Incentive Payment Program
MassHealth did not ensure that DSRIP funding was allocated to ACOs in accordance with the Massachusetts Delivery System Reform Incentive Payment Protocol (Attachment M).
MassHealth Payments for Hospice-Related Services for Dual-Eligible Members
MassHealth did not administer payments to non-hospice providers for hospice-related services in compliance with applicable state and federal regulations, including ensuring that Medicaid is payer of l...
Medicaid Provider Enrollment Performance Audit
The Medicaid Provider Enrollment process in North Carolina did not adequately ensure that only qualified providers were enrolled to serve Medicaid beneficiaries or to receive payments. The Division fa...
Department of Social Services Prescription Drug Oversight
The audit found that while cost containment measures have contributed to reductions in prescription drug payments after 2015, significant control gaps remain, notably the absence of a comprehensive st...