Audit of the Office of Medicaid (MassHealth) - Review of Claims Submitted by Dr. Frederick Wagner Jr.

This is a Massachusetts State Auditor performance audit of MassHealth payments to Dr. Frederick Wagner Jr. for vision care services from 2014 through 2017.

“OSA has conducted an audit of MassHealth claims for vision care services paid to Dr. Frederick Wagner Jr. for the period January 1, 2014 through December 31, 2017.”

The auditor reviewed whether Dr. Wagner billed MassHealth correctly for services like nursing-facility visits, travel, ordering eyeglasses, and dispensing eyeglasses.

“The purpose of this audit was to determine whether Dr. Wagner properly billed MassHealth for these services, including traveling to nursing facilities and ordering and dispensing eyeglasses for MassHealth members.”

MassHealth is a major public program serving many Massachusetts residents and using a large share of the state budget, so incorrect payments affect public money and trust.

“Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.”

If you are a taxpayer or MassHealth member, this audit is about whether public healthcare money was spent properly and whether patient records supported the care billed.

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

The audit concluded that Dr. Wagner did not properly bill MassHealth in some cases, mainly because records did not adequately support the claims and some eyeglass dispensing claims were improper.

“Did Dr. Wagner properly bill MassHealth for vision care services, including transportation and ordering and dispensing of eyewear, provided to its members?”

The auditor recommended repayment, and MassHealth said it would recover overpayments from Dr. Wagner.

“MassHealth will recoup overpayments from Dr. Wagner as a result of the audit findings.”

The audit is significant because many patients in the sample had conditions that could make it hard for them to advocate for themselves, making accurate records especially important.

“These vulnerable populations of MassHealth members are often poorly served and unable to advocate for themselves.”

A “chief complaint” means the recorded reason for a patient visit, such as the symptom, condition, diagnosis, or other reason the provider saw the patient.

“A concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for the encounter, usually stated in the patient’s own words.”