Office of Medicaid (MassHealth)-Review of Claims Submitted by Hudson Home Health Care, Inc.

This is a Massachusetts State Auditor review of claims Hudson Home Health Care submitted to MassHealth for wheelchairs and wheelchair parts from 2012 through 2014.

“The Office of the State Auditor has conducted an audit of claims for wheelchairs and wheelchair components submitted by Hudson Home Health Care, Inc.2 to MassHealth for the period January 1, 2012 through December 31, 2014.”

The auditor checked whether Hudson billed and got paid for wheelchair equipment according to state rules.

“The objective of our audit was to determine whether Hudson submitted claims and received payments for these items in accordance with certain established state regulations.”

MassHealth is a very large public program, so billing errors can affect taxpayer money and public trust.

“Medicaid expenditures represent approximately 38% of the Commonwealth’s total annual budget.”

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

“MassHealth provides access to healthcare services to approximately 1.9 million eligible low- and moderate-income children, families, seniors, and people with disabilities annually.”

The audit found two main problems: Hudson billed above the lowest prices it accepted elsewhere, and it was also overpaid for some items MassHealth priced individually.

“Below is a summary of our findings and recommendations, with links to each page listed.”

The report says Hudson should work with MassHealth to figure out and repay overpayments, and MassHealth said it would seek repayment and improve billing guidance.

“MassHealth agrees with the recommendation that Hudson collaborate with MassHealth to repay the overpayment of approximately $474,486 resulting from the overpayments identified through this audit and will work with Hudson to determine whether additional overpayments resulted from similar improper billings.”

The report highlights weaknesses in MassHealth payment controls and says this kind of oversight is important to keep confidence in the Medicaid program.

“As with any government program, public confidence is essential to the success and continued support of the state’s Medicaid program.”

A “usual and customary charge” means the lowest price the provider charges or accepts for the same equipment from any payer, not just a posted price.

“The lowest price that an eligible provider charges or accepts from any payer for the same equipment or item, including but not limited to the shelf price, sale price or advertised price.”