Audit of the Office of Medicaid (MassHealth) - Review of Durable Medical Equipment Providers (October 30, 2025)

This is a state audit of MassHealth payments for durable medical equipment, such as wheelchairs, canes, diabetic supplies, and emergency response systems, from January 1, 2021 through December 31, 2023.

“OSA has conducted a performance audit of MassHealth’s durable medical equipment (DME) providers for the period January 1, 2021 through December 31, 2023.”

The audit checked whether MassHealth was properly watching claims for equipment providers and prescribers, and whether it was preventing payments for equipment ordered for people who had already died.

“The purpose of this audit was to determine whether MassHealth monitored billing and authorization practices for DME providers and prescribers and monitored various death records to ensure that DME was not ordered for or prescribed to members who had already passed away.”

This matters because Medicaid is a major public program, and taxpayers need confidence that MassHealth is paying only proper claims and using public money carefully.

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

If you are a taxpayer or MassHealth member, stronger checks can help protect public money and leave more resources available for legitimate health services.

“Unsupported DME claims represent unallowable costs to the Commonwealth, and MassHealth could have used this money to provide additional services to other MassHealth members or reduce the cost of its services to the Commonwealth.”

The audit found three payment problems: claims missing proof of an eligible ordering provider, claims ordered by providers excluded from Medicaid, and claims for members who were already deceased.

“MassHealth paid providers $27,400 for durable medical equipment that was ordered for members who were deceased.”

The auditor recommended that MassHealth investigate the claims, recover money where appropriate, deny claims tied to excluded or unverified providers, and improve how it identifies deceased members.

“MassHealth should investigate the claims identified in this finding and recoup any overpayments that it deems appropriate.”

MassHealth is a large part of the state budget, so even narrow payment-control problems can involve meaningful public money and affect trust in the program.

“These Medicaid program expenditures represented approximately 33% of the Commonwealth’s total fiscal year 2023 budget.”

Durable medical equipment means reusable medical items used for medical needs, such as crutches, wheelchairs, glucose monitors, nutritional supplements, or emergency response systems.

“Durable medical equipment (DME) refers to medical devices that can withstand repeated use and are primarily used to serve a medical purpose.”