Office of Medicaid (MassHealth) - Review of Vision Care Claims Paid to Dr. Wensheng Yao

This is a Massachusetts State Auditor performance audit of MassHealth vision care claims paid to Dr. Wensheng Yao for services from July 1, 2011 through June 30, 2016.

“OSA has conducted an audit of vision care claims paid to Dr. Wensheng Yao for the period July 1, 2011 through June 30, 2016.”

The audit checked whether the MassHealth-paid vision services were needed, documented, and allowed under MassHealth rules.

“The purpose of this audit was to determine whether vision care services provided to MassHealth members were medically necessary, properly supported by documentation, and allowable in accordance with MassHealth regulations.”

MassHealth is a large public program serving about 1.9 million people, and improper payments can affect public trust and state spending.

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

The auditor concluded that Dr. Yao did not properly bill MassHealth in all cases and identified hundreds of thousands of dollars in overpayments or questionable charges.

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

MassHealth said it would seek repayment, require a corrective action plan, train the provider on billing rules, monitor compliance, and use sanctions if needed.

“MassHealth will initiate recovery of the overpayment from Dr. Yao after the final report has been issued.”

The report found at least $396,962 in overpayments for services billed under Dr. Yao’s provider number but performed by other optometrists, plus as much as $218,784 in questionable eyeglass dispensing charges.

“This resulted in at least $396,962 of overpayments during the audit period.”

“Dispensing services” means helping someone choose frames, measuring for lenses and frames, fitting the finished glasses, checking that the person can see clearly, making adjustments, and giving the glasses to the person.

“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.”