Audit of the Office of Medicaid (MassHealth) - Review of Payment for Telehealth Adult Day Health (October 1, 2024)

This is a state performance audit of MassHealth payments for telehealth adult day health services during 2020 and 2021.

“OSA has conducted a performance audit of MassHealth’s payments for telehealth adult day health (ADH) for the period January 1, 2020 through December 31, 2021.”

The audit checked whether MassHealth was watching telehealth adult day health billing closely enough to make sure providers followed the rules.

“The purpose of this audit was to determine whether MassHealth monitored telehealth practices for ADH to ensure compliance with its regulations.”

When payments are made without approval or records, the state cannot be sure people got the right care or that taxpayer money was spent properly.

“Our audit is designed to identify issues that will help improve the Medicaid program, so taxpayers know their dollars are spent prudently and that there is a system of continuous improvement of efficiency and service over time.”

If you are a taxpayer or MassHealth member, this matters because the audit is about whether public healthcare money is protected and whether services are properly documented.

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

The audit found three main problems: unauthorized or undocumented adult day health payments, unauthorized or undocumented transportation payments, and payments for services allegedly provided after members had died.

“Below is a summary of our findings, the effects of our findings, and our recommendations, with links to each page listed.”

The auditor recommended that MassHealth fix payment controls, review the questioned claims, recover overpayments when appropriate, and improve death-date checks.

“MassHealth should establish a plan to recoup the $11,797 in overpayments made on behalf of deceased members.”

The audit covered a large public program: MassHealth serves about 2.3 million people and paid more than $17.1 billion to healthcare providers in fiscal year 2023.

“In fiscal year 2023, MassHealth paid healthcare providers more than $17.1 billion, of which approximately 35% was funded by the Commonwealth.”

Adult day health means a community program, not overnight care, that provides nursing, supervision, and help with daily activities such as eating, bathing, toileting, or walking.

“Adult day health (ADH) is a community-based, nonresidential service that delivers nursing, supervision, and assistance with daily activities to MassHealth members in an organized group setting.”