Audit of the Office of Medicaid (MassHealth) - Review of Telehealth
November 23, 2022 · Office of Medicaid (MassHealth) · Read the full official report on mass.gov ↗ · official site ↗
Published November 23, 2022 Audit covers January 1, 2020 – June 30, 2021 Under Suzanne M. Bump · 2011–2023
source
“MassHealth made payments totaling at least $91,852,881 to its providers for telehealth behavioral health services that were not properly documented.”
Read the plain-English breakdown
This is a state audit of MassHealth payments for telehealth behavioral health services during the early COVID-19 period.
“OSA has conducted a performance audit of MassHealth’s payments for telehealth1 behavioral health services for the period January 1, 2020 through June 30, 2021.”
Auditors wanted to check whether MassHealth was making sure telehealth behavioral health visits followed its rules.
“The purpose of this audit was to determine whether MassHealth monitored telehealth practices for behavioral health services to ensure compliance with its All Provider Bulletins 281, 289, 291, 298, 303, and 314.”
Medicaid is a major public program, so weak oversight can affect public trust and taxpayer money.
“As with any government program, public confidence is essential to the success and continued support of the state’s Medicaid program.”
Telehealth can make it easier for MassHealth members to get behavioral healthcare without traveling to an office.
“By allowing these services to be provided via telehealth, MassHealth allows its members to receive care from providers they might not otherwise be able to see in person.”
The auditor concluded that every sampled claim had at least one documentation problem.
“Each of the 47 claims had at least one issue.”
The auditor says MassHealth should train providers and add checks so telehealth visits are documented properly.
“MassHealth should train its providers, and establish monitoring controls, to ensure that telehealth services are documented in accordance with its All Provider Bulletins.”
The amount at issue was large: auditors estimated at least $91.9 million in telehealth behavioral health payments lacked proper documentation.
“Based on this, we are 90% confident that the minimum amount of overpaid telehealth behavioral health service claims was $91,852,881 and the maximum amount was $96,464,816.”
Telehealth means getting certain healthcare services by phone or video instead of going in person.
“Telehealth allows patients to receive certain services without meeting with their providers in person.”
2 figure(s) pending source verification - not shown
What the Auditor checked
- Did not comply Does MassHealth monitor telehealth practices for behavioral health services to ensure compliance with the “Requirements for Telehealth Encounters” section of Appendix A in its All Provider Bulletins 281, 289, 291, 298, 303, and 314?
What the Auditor found
Why it matters: The lack of documentation calls into question whether the services were properly delivered.
Standard: MassHealth’s All Provider Bulletins 281, 289, 291, 303, and 314 telehealth documentation and recordkeeping requirements. ( MassHealth’s All Provider Bulletin 314; MassHealth’s All Provider Bulletins 281, 289, 291, and 303 )
1 recommendation
- MassHealth should train its providers, and establish monitoring controls, to ensure that telehealth services are documented in accordance with its All Provider Bulletins.agency: disagreed
Agency response & Auditor reply
Agency: "MassHealth disagrees that it “made payments totaling at least $91,852,881 to its providers for telehealth behavioral health services that were not properly documented.”"
Auditor: "OSA acknowledges that MassHealth’s All Provider Bulletin 314 does not specifically require providers to document compliance with MassHealth’s required best practices in each member’s medical record."
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