Audit of Office of Medicaid (MassHealth) - Review of Drug Testing Frequency

This is a Massachusetts State Auditor performance audit looking at MassHealth payments for drug testing from July 1, 2012 through June 30, 2016.

“OSA has conducted an audit of MassHealth’s drug tests for the period July 1, 2012 through June 30, 2016.”

The audit checked whether MassHealth was paying only for drug tests that were connected to diagnosis, treatment, or medical need.

“The purpose of this audit was to review the drug tests that MassHealth paid for during the audit period and determine whether the nature and frequency of testing complied with MassHealth regulations, which allow authorized prescribers treating MassHealth members to order and use drug tests for diagnosis, treatment, or otherwise medically necessary purposes.”

This matters because MassHealth is a major public program, and the report says public trust is important to keeping support for Medicaid.

“As with any government program, public confidence is essential to the success and continued support of the state’s Medicaid program.”

For an ordinary taxpayer or MassHealth member, the issue is whether public healthcare money was spent on drug tests that were truly needed instead of being wasted.

“These funds could have been used to pay for other medical services to MassHealth members.”

The auditor concluded that MassHealth did not always pay only for drug tests tied to diagnosis, treatment, or medical necessity.

“Did MassHealth only pay for drug tests that were used for diagnosis, treatment, or otherwise medically necessary purposes?”

The auditor recommended stronger controls, better claim information, reviews of lab paperwork, and repayment for unsupported payments.

“MassHealth should collaborate with the laboratory discussed in this finding to establish a plan for repayment of the $21,073 in overpayments for improper laboratory drug test billings.”

The report is significant because MassHealth paid about $39.8 million for drug tests for more than 240,000 members during the audit period, and the auditor questioned millions of dollars in payments.

“During this period, MassHealth paid laboratories approximately $39,771,152 to provide drug tests for 240,711 MassHealth members.”

In plain terms, “residential monitoring” means drug testing required by a sober home to check whether residents are using alcohol or drugs, rather than testing that is tied to medical treatment.

“This type of testing is referred to as residential monitoring, since the sober home requires it in order to ensure that a resident is not abusing alcohol or drugs.”