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…
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…
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…
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.
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 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…