Medicaid Audit Intelligence

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Medicaid audit reports

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Evidence register

7 reports

Published
Oct 30, 2025
Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Report ID
REPORT 122

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 data-lag issues necessitate strengthened controls and more comprehensive deat…

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0
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0
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Source status
Original source
Published
Mar 1, 2024
Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Report ID
REPORT 73

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 recommendations (three fully implemented and one in progress). Follow-up post-audit s…

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0
Recommendations
0
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Source status
Original source
Published
Jun 28, 2023
Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Report ID
REPORT 96

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 in overpayments and issued recommendations to strengthen residency verificatio…

Findings
0
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0
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Source status
Original source
Published
Nov 23, 2022
Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Report ID
REPORT 75

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.

Findings
0
Recommendations
0
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Source status
Original source
Published
Jul 20, 2021
Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Report ID
REPORT 74

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 last resort and that hospice election data and service coordination were prope…

Findings
0
Recommendations
0
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Source status
Original source