Audit of the Office of Medicaid (MassHealth) - Review of Claims Paid for Services by ActiveLife Adult Day Care, Inc.
November 14, 2019 · Office of Medicaid (MassHealth) · Read the full official report on mass.gov ↗ · official site ↗
Published November 14, 2019 Audit covers January 1, 2016 – December 31, 2017 Under Suzanne M. Bump · 2011–2023
source
“ActiveLife did not obtain a physician order for $34,137 of services for one MassHealth member.”
Read the plain-English breakdown
This is a state audit of MassHealth payments to ActiveLife Adult Day Care for adult day health services during 2016 and 2017.
“OSA has conducted an audit of MassHealth claims for adult day health (ADH) services paid to ActiveLife Adult Day Care, Inc. for the period January 1, 2016 through December 31, 2017.”
The audit checked whether ActiveLife billed MassHealth correctly for adult day health services.
“The purpose of this audit was to determine whether ActiveLife properly billed for ADH services provided to MassHealth members during our audit period.”
MassHealth is a major public program, and the auditor says confidence in it depends on preventing improper payments.
“As with any government program, public confidence is essential to the success and continued support of the state’s Medicaid program.”
If you are a taxpayer or MassHealth member, this audit is about whether public healthcare dollars were paid only when required paperwork supported the services.
“During this period, MassHealth paid ActiveLife approximately $2,365,604 to provide ADH services for 108 MassHealth members.”
The auditor concluded ActiveLife did not properly bill in at least one tested case because a required physician order was missing.
“For 1 of the 40 MassHealth members tested, ActiveLife lacked a properly authorized physician order to authorize $34,137 of adult day health (ADH) services provided during our audit period.”
ActiveLife was told to work with MassHealth on how much money, if any, should be repaid, and to put better procedures in place before providing services.
“ActiveLife should collaborate with MassHealth to determine how much of the $34,137 discussed in this finding should be repaid.”
The issue was limited in the audit findings, but it raised concern that without required physician orders, there is too much risk that services may not have been appropriate.
“As a result, there is a higher-than-acceptable risk that ActiveLife may not have provided the appropriate ADH services to this member.”
ADH means adult day health: services for eligible MassHealth members who need help with daily activities like eating, bathing, walking, toileting, or medication.
“MassHealth covers ADH services for eligible MassHealth members who need assistance with activities of daily living such as eating, toileting, bathing, walking, and taking medication.”
1 figure(s) pending source verification - not shown
What the Auditor checked
- Did not comply Did ActiveLife properly bill for adult day health (ADH) medical services provided to MassHealth members?
What the Auditor found
Why it matters: There is a higher-than-acceptable risk that ActiveLife may not have provided the appropriate adult day health services to the member.
Standard: Section 404.406(F)(2) of Title 130 of the Code of Massachusetts Regulations as of March 2010 ( Section 404.406(F)(2) of Title 130 of the Code of Massachusetts Regulations )
2 recommendations
- ActiveLife should collaborate with MassHealth to determine how much of the $34,137 discussed in this finding should be repaid.
- ActiveLife should develop policies and procedures to ensure that completed and authorized physician orders are in place before it provides ADH services to MassHealth members.
Agency response & Auditor reply
Agency: "Even if the primary care physician is unable to produce a copy of this PO, though, it would be inequitable for MassHealth to recoup $34,137 from ActiveLife due to a one-time, inadvertent administrative error."
Auditor: "As noted above, none of the documentation in the member file in question included a physician order for ADH services."
More audits of this entity
Other Office of the State Auditor reports on Office of Medicaid (MassHealth) .
- Audit of the Office of Medicaid (MassHealth) - Review of Payment for Telehealth Adult Foster Care and Group Adult Foster Care (September 4, 2024)MassHealth / Medicaid · September 4, 2024
- Audit of the Office of Medicaid (MassHealth) - Review of Claims Submitted by Dr. Frederick Wagner Jr.MassHealth / Medicaid · September 24, 2019
- Audit of the Office of Medicaid (MassHealth) - Review of Claims Paid for Services by Beyond Healthcare Agency, LLCMassHealth / Medicaid · September 21, 2020
- Audit of the Office of Medicaid (MassHealth) - Review of Claims Paid for Services by City Home Care, LLCMassHealth / Medicaid · September 21, 2020
- Office of Medicaid (MassHealth) - Review of Hospice Care Billing: HopeHealth Massachusetts, Inc.MassHealth / Medicaid · September 21, 2017
- Audit of the Office of Medicaid (MassHealth) - Review of Claims Paid for Day Habilitation Services Provided by United Cerebral Palsy (UCP)MassHealth / Medicaid · September 19, 2019
- Office of Medicaid (MassHealth) Review of Controls over Mobility-Assistive EquipmentMassHealth / Medicaid · September 16, 2015
- Audit of the Office of Medicaid (MassHealth) - A Review of MassHealth Member Eligibility at the Chelsea Enrollment CenterMassHealth / Medicaid · October 9, 2020
- Audit of the Office of Medicaid (MassHealth) - A Review of MassHealth Member Eligibility at the Springfield Enrollment CenterMassHealth / Medicaid · October 9, 2020
- Audit of the Office of Medicaid (MassHealth) - A Review of MassHealth Member Eligibility at the Taunton Enrollment CenterMassHealth / Medicaid · October 9, 2020
- Audit of the Office of Medicaid (MassHealth) - A Review of MassHealth Member Eligibility at the Tewksbury Enrollment CenterMassHealth / Medicaid · October 9, 2020
- Office of Medicaid (MassHealth) Claims for Wheelchair-Van Services SubmittedMassHealth / Medicaid · October 5, 2015