BOSTON, MA —Today State Auditor Suzanne M. Bump released an audit examining MassHealth payments for drug tests and drug screens. The audit found that over the nearly four year audit period MassHealth overpaid claims for these services by as much as $4.38 million. The majority of the improper payments were a result of a practice known as “unbundling,” in which providers bill MassHealth for multiple procedures individually, rather than billing them in a comprehensive and less expensive manner. Sixty-seven percent of “unbundled” claims found by Bump’s audit involved multiple providers submitting claims for drug screens and drug tests for the same member on the same day. The audit notes that the remaining amount was a result of MassHealth paying for duplicate drug test services totaling approximately $198,000.
Today’s audit follows a 2013 audit that found MassHealth’s claims processing system failed to prevent millions of dollars of improper payments for drug tests and drug screens. The audit released today sought to evaluate whether the steps taken by MassHealth had addressed the problems.
“This audit shows that measures taken by MassHealth have not fully addressed problems related to drug screening and testing. More work is needed to stop additional money from being wasted,” Bump said. “MassHealth needs to take stronger measures to stop drug labs from ripping off taxpayers.”
MassHealth pointed to staff resources as one factor preventing it from addressing some of the improper payments identified in a timely manner. Its payment system flags claims that it suspects are “unbundled” but does not prevent or delay the payment. The agency then relied on staff to investigate those claims to determine whether they were improper and recoup money as appropriate. However, the agency noted that it often lacked the resources to do this research, which allowed the improper payments to go unchecked. In an effort to address this issue, MassHealth made changes to its claim payment system to deny these claims. However further examination by Bump’s office shows these changes have not fully addressed this problem. MassHealth continued to pay nearly half-a-million dollars for these improper claims in the first half of 2017, after it stated that this change was implemented.
In fiscal year 2017, MassHealth paid healthcare providers $15.3 billion for services for approximately 1.9 million low-and-moderate income individuals. MassHealth is the state’s largest program and accounts for approximately thirty-nine percent of the state budget.
The audit is attached, and available online here.