Audit of the Office of Medicaid (MassHealth) - Review of Transportation Services (May 8, 2025)

This is a State Auditor performance audit of MassHealth payments for nonemergency transportation services, such as rides to medical appointments, covering July 1, 2020 through June 30, 2023.

“The Office of the State Auditor has conducted an audit of payments made by MassHealth for nonemergency transportation services for the period July 1, 2020 through June 30, 2023.”

The Auditor reviewed the program to check whether rides were fairly assigned, properly approved and documented, and whether driver background checks were done as required.

“The purpose of this audit was to determine whether MassHealth ensured that its broker process provides equal opportunity to contracted transportation providers, whether transportation services were properly authorized and documented in accordance with Sections 407.421(D) and 450.205(A) of Title 130 of the Code of Massachusetts Regulations (CMR), and whether Criminal Offender Record Information checks were consistently completed and documented for transportation drivers in accordance with 130 CMR 407.405(B).”

This matters because MassHealth is a large public program, and transportation payments come from public funds intended to help eligible people get medical care.

“In fiscal year 2024, MassHealth program expenditures totaled $20.1 billion, of which approximately 39% was paid by the Commonwealth.”

For an ordinary resident, the issue is whether taxpayer-supported MassHealth transportation money is being spent only on real, properly documented rides for covered medical care.

“Without sufficient evidence of trips, MassHealth may be paying for transportation services that did not take place.”

The Auditor estimated that MassHealth overpaid at least about $1.67 million for these transportation services and said some claims were unallowable costs to the state.

“We extrapolated the test results related to the four unallowable nonemergency transportation claims to the entire population and estimate that MassHealth overpaid at least $1,669,323 for nonemergency transportation services.”

MassHealth said it agrees with the recommendations, will improve documentation systems and audits, and will seek repayment where overpayments are supported by the findings.

“EOHHS will review the OSA’s findings and recoup any overpayments where the brokers and transportation providers were unable to produce documentation reflecting the transportation billed to MassHealth.”

The audit found problems with documentation and some payments, but it also found that the broker process gave providers equal opportunity and that required CORI checks were completed.

“Based on our testing, we determined that CORI checks were completed on all drivers and attendants, in accordance with MassHealth regulations.”

A PT-1 form is the paperwork used to show that a MassHealth member needs brokered transportation for medical reasons and that the ride is authorized.

“The PT-1 form documents the medical necessity of the transportation requested and its authorization by appropriate personnel.”