Office of Medicaid (MassHealth) - Review of Claims for Durable Medical Equipment

This is a state audit of MassHealth payments for durable medical equipment, such as wheelchairs, walkers, oxygen equipment, and similar medical supplies.

“OSA has conducted an audit of claims paid for durable medical equipment (DME) for the period July 1, 2010 through December 31, 2015.”

The auditor reviewed these claims to see whether MassHealth followed the rules when paying providers for durable medical equipment.

“The purpose of this audit was to analyze MassHealth’s payment information for DME claims and determine whether MassHealth paid claims for DME in accordance with applicable laws, rules, and regulations.”

The report says the overpayments wasted public money that could have gone to other services.

“These duplicate payments represent wasted Commonwealth funds that could have been used for other needed services.”

If you are a Massachusetts resident or taxpayer, this matters because MassHealth is a large public program funded by state and federal money, and payment errors affect how public dollars are used.

“Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.”

The audit found two main problems: MassHealth paid some providers more than allowed, and it also made duplicate payments.

“The audit focused on two specific types of overpayments: (1) payments made at rates higher than those established by state regulations and the state rate schedule and (2) duplicate payments.”

The auditor recommended that MassHealth fix its systems and recover the identified overpayments; MassHealth said it would recover validated overpayments.

“MassHealth agrees with [Recommendation 3] and will recoup all validated overpayments.”

The report describes the issue as systemic, meaning it was not just one mistaken bill or one provider; it reflected weaknesses in MassHealth’s claim-processing system.

“This indicates a systemic problem in MassHealth’s claim-processing system, not an isolated problem with a single provider.”

Durable medical equipment means medically needed equipment and supplies like wheelchairs, canes, walkers, ventilators, oxygen, and hospital bed accessories.

“DME includes, but is not limited to, wheelchairs (manual and electric), traction equipment, canes, crutches, walkers, kidney machines, ventilators, oxygen, monitors, pressure mattresses, lifts, and nebulizers.”