Medicaid Audit Intelligence

Evidence record

MassHealth Telehealth Review

Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Publication date
November 23, 2022
Source record
Original document linked
Open original reportOriginal source available

Findings

1

Recommendations

1

Overall conclusion

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.

Scope

The audit covers MassHealth's payments for telehealth behavioral health services during January 1, 2020 through June 30, 2021. It examines whether MassHealth monitored telehealth practices to ensure compliance with All Provider Bulletins 281, 289, 291, 298, 303, and 314, including documentation requirements for telehealth encounters (e.g., patient identification, provider identity/credentials, medical history review, consent and privacy, distant and originating sites, and emergency planning). The audit used a random statistical sample of 47 telehealth behavioral health claims from a population of 1,306,414 claims totaling $96,464,816 for the audit period, with 90% confidence, to extrapolate results. It found at least $91,852,881 in overpayments and up to $96,464,816 total population paid for telehealth behavioral health services not properly documented. The audit also analyzed data reliability through prior OSA work on MMIS controls and referenced MassHealth policy changes, including All Provider Bulletins 281, 289, 291, 298, 303, 314, and 355. The period includes context around the COVID-19 emergency and related telehealth expansions.

Findings (1)

Each finding has a stable link.

  1. F-613

    MassHealth made payments totaling at least $91,852,881 to its providers for telehealth behavioral health services that were not properly documented.

Recommendations (1)

  1. R-549

    Train MassHealth providers and establish monitoring controls to ensure telehealth services are documented in accordance with All Provider Bulletins 281, 289, 291, 298, 303, and 314.

    Related finding F-613