Audit Questions $35M In State Medicaid Payments

A state audit has identified $35 million of what were called "questionable and unallowable" payments by the state's Medicaid program.

Massachusetts State Auditor Suzanne M. Bump (Josh Reynolds/AP)
Massachusetts State Auditor Suzanne M. Bump (Josh Reynolds/AP)

Auditor Suzanne Bump said Wednesday that her office and MassHealth disagree in their interpretations of federal and state rules that govern the program.

The audit focused on MassHealth's Limited Program, which covers eligible non-citizens.

While federal land state rules are supposed to restrict coverage under the program to emergency medical services, Bump says auditors found that MassHealth often paid claims even when a provider indicated that a service was not of an emergency nature.

She says MassHealth "regularly substituted its own judgment for that of the medical profession."

State officials strongly disputed the findings, saying they disagreed with the auditor's definition of emergency medical services.


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