Audit of the Office of Medicaid (MassHealth) - Review of Claims Paid for Services by Old Colony Elder Services (OCES)

This is a state audit of MassHealth payments to Old Colony Elder Services for adult foster care from January 1, 2016 through December 31, 2018.

“OSA has conducted an audit of MassHealth claims for adult foster care (AFC) paid to Old Colony Elder Services (OCES) for the period January 1, 2016 through December 31, 2018.”

The audit checked whether Old Colony Elder Services billed MassHealth properly for adult foster care.

“The purpose of this audit was to determine whether OCES properly billed for AFC provided to MassHealth members during our audit period.”

This matters because MassHealth is a large public program funded partly by state money, and the auditor says public trust is important.

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

For ordinary residents, the audit is about whether taxpayer-supported healthcare money was paid only for services that had the required approval.

“As a result, MassHealth paid for AFC that it did not authorize.”

The main finding was that Old Colony Elder Services missed many required annual approvals in the sample auditors reviewed.

“Specifically, for 40 of 208 MassHealth members who received AFC, OCES did not submit 55 (58%) of 95 required annual prior authorizations.”

Old Colony Elder Services said it started submitting the required annual approvals once the MassHealth online portal became available.

“OCES officials told us that OCES began submitting annual prior authorizations on April 16, 2019, the day MassHealth’s Long-Term Services and Supports Provider Portal became operational.”

The issue is financially significant because MassHealth paid Old Colony Elder Services more than $9 million for adult foster care claims during the audit period.

“During this period, MassHealth paid OCES $9,386,577 for 6,315 claims to provide AFC for 217 MassHealth members.”

Adult foster care means help for older adults or people with disabilities with everyday tasks so they can keep living outside a long-term-care facility.

“Both programs are designed to provide sufficient assistance to allow members to continue to live independently and avoid the high cost of a long-term-care facility.”