Auditor Bump Finds MassHealth Paying Doctors Prohibited by Feds

A recent audit turned up nearly half a million in payments.

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State Auditor Suzanne Bump. Courtesy Photo

State Auditor Suzanne Bump has found that MassHealth, the commonwealth’s Medicaid program, has made nearly half a million dollars in payments to doctors prohibited by the federal government from participating in the program.

“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 Wednesday.

Bump’s office found that 12 providers, banned from participating in MassHealth for federal violations including patient abuse and healthcare fraud,  were paid $476,787 for 5,534 claims for medical services and prescriptions.

“The inclusion of prohibited providers in the MassHealth program represents a violation of public trust,” Bump said. “MassHealth must quickly address this issue in order to ensure the safety of program participants.”

The audit also found that MassHealth paid $50,682 for 3,445 pharmacy claims for prescriptions written by seven prohibited providers. Of these prescriptions, 330 were for opiates and amphetamines.