Massachusetts' Suzanne Bump found the state's Medicaid program, MassHealth, issued improper or questionable fee-for-service payments totaling $193 million to physicians for mental health services.
According to an audit report issued April 3, MassHealth directly paid physicians for care that should have been reimbursed by the Massachusetts Behavior Health Partnership. MassHealth contracts MBHP to manage mental health services for certain Medicaid beneficiaries at a fixed monthly fee.
Ms. Bump said, between July 2010 and June 2015, MassHealth made $93 million improper provider payments and an additional $100 million questionable payments for services MBHP was contracted to pay.
"This audit is the latest example of poor claims administration at MassHealth," Ms. Bump said. "Some of the problems identified stem from MassHealth and its contractors' different understandings of who is to pay what; other times MassHealth simply acts contrary to its own rules and standards."
MassHealth argued the audit wrongly included claims with medical treatment components, making the agency, not MBHP, accountable for the payments. However, Ms. Bump said she did not include those claims in the analysis.
Ms. Bump concluded MassHealth should "immediately improve its processes to prevent any further improper payments, and determine whether it can recoup any monies paid."