Massachusetts Medicaid Audit Reports
Review Medicaid audit findings, recommendations, and oversight activity for Massachusetts. Use this page to jump into report summaries or continue exploring the full library.
Recent 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 ...
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.
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...
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...