Audit of the Office of Medicaid (MassHealth) - Review of Vision Care Claims Paid to Dr. Khuong Nguyen

This is a Massachusetts State Auditor performance audit of vision care claims MassHealth paid to Dr. Khuong Nguyen for services from July 1, 2011 through December 31, 2016.

“OSA has conducted an audit of vision care claims paid to Dr. Khuong Nguyen for the period July 1, 2011 through December 31, 2016.”

The State Auditor reviewed these claims as part of its oversight role to identify fraud, waste, abuse, and improper Medicaid payments.

“The audit was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program.”

MassHealth is a large public healthcare program, and questionable payments mean public money may not be used as intended.

“Medicaid expenditures represent approximately 41% of the Commonwealth’s total annual budget.”

If you are a taxpayer or MassHealth member, this audit is about whether public healthcare dollars were spent properly and whether providers followed the rules.

“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. Nguyen did not properly bill MassHealth in all reviewed areas, citing missing records, questionable dispensing claims, and inadequate documentation.

“Did Dr. Nguyen properly bill MassHealth for vision care services he provided to its members?”

MassHealth said it would work out the overpayment amounts and seek repayment after the final audit report.

“MassHealth will determine the overpayment amount and initiate recovery from Dr. Nguyen after the final audit report has been issued.”

The largest specific issue was up to $108,166 in questionable eyeglass-dispensing payments, plus other findings involving missing or inadequate documentation.

“Dr. Nguyen was overpaid by as much as $108,166 on 3,858 billings for eyeglass dispensing services.”

“Dispensing services” means helping choose frames, measuring and ordering lenses and frames, fitting the finished glasses, checking that the person can see clearly, adjusting the glasses, and giving them to the member.

“The following are considered dispensing services: assisting a member in choosing appropriate frames, taking necessary measurements for ordering lenses and frames from the optical supplier, fitting the completed eyeglasses to the member, determining whether the member can see clearly through the eyeglasses, making necessary adjustments to the lenses and/or frames, and giving the member the eyeglasses.”