The Carson Center for Human Services, Inc.

This is a Massachusetts State Auditor report about Carson Center for Human Services, a nonprofit that provided mental health and related services in western Massachusetts.

“The Carson Center offers a comprehensive program of rehabilitative services, including: residential care, outpatient care, daycare, and educational services.”

Auditors checked whether Carson Center’s bills to MassHealth and the Department of Developmental Services were allowed, accurate, documented, and within the rules.

“The purpose of our audit was to determine whether Carson Center submitted allowable claims to MassHealth and the Department of Developmental Services (DDS) for mental health and related services during the period July 1, 2008 through September 30, 2010.”

Most of Carson Center’s funding came from the Commonwealth, including Medicaid money, so billing errors affected public funds.

“For fiscal years 2009 and 2010, Carson Center received program funding totaling $25,927,015, of which the Commonwealth provided $22,120,917, or approximately 85%, which included $8,251,091 of Medicaid funding.”

For taxpayers and MassHealth members, the report shows whether public healthcare dollars were being billed properly and whether overpayments were caught.

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

Aside from the overpayment issue, the auditors found the tested claims complied with applicable requirements.

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

The auditor recommended that MassHealth check its system, Carson Center improve controls, and both sides arrange repayment of the overpaid money.

“Additionally, we recommend that MassHealth and Carson Center develop a repayment schedule for the overpayments.”

The dollar amount was small compared with Carson Center’s funding, but the finding showed a claims-processing weakness that allowed payments above state limits.

“However, MassHealth’s claims processing system failed to identify the problem.”