Massachusetts paid banned providers for services, opiate prescriptions
BOSTON >> MassHealth made payments to seven "prohibited providers" for opiates, amphetamines and other controlled substances, according to audit results released Wednesday.
Auditors found the massive publicly funded health insurance program paid $50,682 for 3,445 claims for prescriptions written by the seven banned providers, according to Auditor Suzanne Bump's office.
Overall, the audit released Wednesday determined that MassHealth paid $476,787 for services or prescriptions from doctors that are disallowed by federal law from participating in the program due to convictions related to patient abuse, health care fraud, and other federal violations.
"In discussions with our colleagues in other states, we learned this is a problem throughout the country so we conducted data analytics to determine whether the problem existed here. That analysis turned up a sufficient level of concern that led us to conduct this audit," Bump said in a statement. "The inclusion of prohibited providers in the MassHealth program represents a violation of public trust. MassHealth must quickly address this issue in order to ensure the safety of program participants."
Auditors learned that 12 excluded providers were paid for 5,534 claims for medical services for 1,802 MassHealth members. Most of the claims were made by managed care organizations, the audit said.
The findings come a day after Bump released a separate audit of a Franklin-based medical equipment provider showing improper billing practices that resulted in $557,006 in overpayments from MassHealth for wheelchair components.
In an interview on Boston Herald Radio Wednesday, Bump said as MassHealth grows to take up "an increasingly large chunk of state government spending," financial waste of any size remains important to catch.
"Only half a million here and half a million there, you know how that goes," Bump said. "All of these inefficiencies and failures to conform to the rules do have consequences for the taxpayer."
Both Gov. Charlie Baker and the House Ways and Means Committee have proposed $15.4 billion budgets for MassHealth in fiscal year 2017, a sum that would make up nearly 40 percent of state spending.
The auditor's office is "constantly looking at the MassHealth budget," with the agency the subject of "five or six audits at any given time," Bump said during her radio appearance.
"We are continuously working with the agency to identify lots of ways that we can tighten up this program, and we need to," Bump said of MassHealth. "The integrity of these programs is — if that's under question, then taxpayers aren't going to maintain their support for this program."
MassHealth staff have been "quite responsive" to audit results, Bump said. A spokeswoman for MassHealth contacted by the News Service early Wednesday afternoon did not provide a timely response to the audit's findings.
"Whereas in recent years the focus in the program really was on bringing people in and expanding services, now they realize they've really got to focus on the administration of the program, so program integrity and operation are a chief concern of the current MassHealth director," Bump said.
In the audit released Tuesday, Bump's office found that the equipment supplier, Hudson Home Health Care, was not billing MassHealth at the lowest possible rate for certain wheelchair components, resulting in overpayments of $474,486. The company was overpaid by approximately $82,520 for wheelchair components for which pricing was not clearly defined and which were individually priced by MassHealth, according to the audit.
"MassHealth has policies and rates in place to ensure that they get the best rate for medical equipment. This provides significant savings to the people of Massachusetts," Bump said in a statement. "However, when these policies and rates are not enforced, taxpayers are left on the hook. During our audit, MassHealth informed us that they recognize this problem and expressed a commitment to addressing this issue."
MassHealth agreed with the audit findings and plans to work with Hudson to find recoupment opportunities and prevent similar overpayments in the future, according to Bump's office.
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