Audit Of MassHealth Finds Problems With $4M In Spending

A new state audit takes issue with how MassHealth, the state's health insurance for low-income residents, spent $4 million, WBUR reports.

State Auditor Suzanne Bump says she found problems with how payments for wheelchairs and wheelchair parts were authorized.  "We found that there were not proper authorizations for claims, we also found that nursing homes had submitted duplicative bills," she said in an interview.

Bump says that more controls need to be put in place to make sure only necessary payments are made. MassHealth, with a budget over $12 billion that accounts for about one-third of the state budget, says it's implementing new oversight programs to prevent and recoup the excess payments.

Here are more findings, from the state auditor's news release:

•MassHealth regulations require it pay providers for wheelchairs and component parts at a rate equal to the lowest usual and customary amount the provider accepts from any other insurance carrier. By failing to do so, it spent $1 million more than was necessary during the audit period.

•MassHealth paid $2.9 million in repair claims for wheelchairs and components without proper authorization. Prior authorization is required for claims for wheelchair repairs exceeding $1,000. Because the Prior Authorization Unit improperly calculated total repair costs, including labor and costs, $2.9 million in claims were not properly authorized.

•MassHealth made payments totaling $540,801 for improperly authorized, provided, or billed wheelchair components because the agency’s claims system could not detect when limits and restrictions on equipment had been reached. For example, auditors identified $40,206 in duplicative payments and $158,594 for components or repairs to manual wheelchairs used by members residing in nursing homes.

Correction: An earlier version of this story put the MassHealth budget at "over $12 million" however the correct figure is "over $12 billion."


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