Community Counseling of Bristol County, Inc.

This is a state audit of Community Counseling of Bristol County, a nonprofit mental health provider, focused on whether its MassHealth billing was allowable.

“The scope of our audit was limited to determining whether CCBC submitted allowable claims to MassHealth for behavioral health services during the period July 1, 2008 through September 30, 2010.”

The auditor reviewed CCBC because it received significant Medicaid money for behavioral health services, and the state wanted to check whether those claims followed the rules.

“For fiscal year 2010, CCBC received Medicaid payments totaling approximately $9 million.”

This matters because MassHealth is taxpayer-funded Medicaid, and billing errors can mean public money is paid out when it should not be.

“MassHealth, within the Massachusetts Executive Office of Health and Human Services, administers the state’s Medicaid program, which provides access to healthcare services, including behavioral health services, to approximately one million eligible low- and moderate-income individuals and families annually.”

For an ordinary resident, the main takeaway is that the audit checked whether public healthcare dollars were being billed properly and found a small duplicate-payment issue to recover.

“Additionally, MassHealth should seek reimbursement from CCBC in the amount of $7,918.”

Aside from the duplicate payments, the auditor said the claims tested generally followed applicable rules.

“Based on our review we have concluded that, for the period July 1, 2008 through September 30, 2010, except for the issue addressed in the Audit Results section of this report, CCBC submitted claims to MassHealth for behavioral health services that complied with applicable laws, rules, and regulations for the areas tested.”

MassHealth was expected to look into its claims system and recover the $7,918 from CCBC.

“We agree that MassHealth should examine its claims processing system to determine whether coding changes are necessary to identify and deny duplicate payments such as the ones we identified during our audit of CCBC.”

The finding was narrow: 18 members’ services were paid twice, totaling $7,918, rather than a broad finding that CCBC’s billing was generally improper.

“Our review found that Community Counseling of Bristol County, Inc. (CCBC) was paid twice by MassHealth for the same behavioral health services it provided to 18 members.”

A “crossover” means a person covered by both MassHealth and Medicare; providers bill Medicare first, and MassHealth may cover what remains.

“MassHealth refers to individuals who are eligible for both MassHealth (Medicaid) and Medicare benefits as “crossovers.””