Evidence record
Review of Durable Medical Equipment Providers
- Jurisdiction
- Massachusetts
- Publishing agency
- Massachusetts Office of the State Auditor
- Publication date
- October 30, 2025
- Source record
- Original document linked
Findings
3
Recommendations
6
Overall conclusion
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 data-lag issues necessitate strengthened controls and more comprehensive death data sources.
Scope
The audit evaluated MassHealth durable medical equipment (DME) providers for the period January 1, 2021 through December 31, 2023, including verification of ordering providers, exclusions, and member death status within MMIS and related data sources.
Findings (3)
Each finding has a stable link.
- F-1018
MassHealth paid an estimated $521,526 for durable medical equipment that could not be verified as having been ordered by an eligible provider.
- F-1019
MassHealth paid $31,724 for durable medical equipment that was ordered by providers who were excluded from participating in Medicaid.
- F-1020
MassHealth paid providers $27,400 for durable medical equipment that was ordered for members who were deceased.
Recommendations (6)
- R-902
MassHealth should investigate the identified claims and recoup any overpayments determined to be appropriate.
- R-901
MassHealth should not pay claims for DME that do not have a licensed provider’s name and NPI on the DME order form.
Related finding F-1018 - R-903
MassHealth should develop procedures to deny any DME claims that are ordered, referred, or prescribed by providers who are excluded from Medicaid or whose licenses are suspended or terminated.
Related finding F-1019 - R-904
MassHealth should evaluate and recover overpayments tied to excluded providers or suspended/terminated licenses as appropriate.
Related finding F-1019 - R-905
MassHealth should investigate the deceased-member claims and recoup overpayments that are deemed appropriate.
Related finding F-1020 - R-906
MassHealth should reduce the lag between a member’s death and MMIS entry and employ additional data sources to verify death status.
Related finding F-1020