Auditor Bump Uncovers $17.6 Million in Faulty MassHealth Payments

The billings were “unallowable, questionable, duplicative, unauthorized, or potentially fraudulent.”

Suzanne Bump

Suzanne Bump/photo provided

State Auditor Suzanne Bump announced Wednesday that her office uncovered almost $18 million in “unallowable, questionable, duplicative, unauthorized, or potentially fraudulent” billings at MassHealth, the state’s Medicaid program.

“There are far too many provider bills that get paid despite the fact they are duplicative of other payments, lack supporting documentation, or violate regulations governing what is and what is not reimbursable,” Bump says in a statement. “It is frankly frustrating to see evidence of so many ways that money is being inappropriately spent.”

During fiscal year 2016, MassHealth—which covers 1.9 million people and makes up roughly a third of the state’s budget—paid healthcare providers a total of $14.8 billion. Out of that sum, Bump’s office says, $17.6 million was paid erroneously. With corrective actions meant to curb such transactions, the auditor estimates Massachusetts could save $8.6 million each year.

Among other issues, Bump’s office found reimbursements to providers barred from the MassHealth program; duplicative payments for individuals in adult and group foster care; and payments to dental providers who gave services out of compliance with MassHealth regulations.

This isn’t the first time MassHealth has been in hot water. Within the past year, Bump’s office has cited the program for inappropriate adult foster care payments, wasteful payments to Worcester’s Centro Las Americas, and payments to doctors prohibited from participating in MassHealth. Before that, Bump’s office discovered $500 million in incorrect payments made between October 2009 and September 2014.