State paid banned providers for services, opiate prescriptions
MassHealth made payments to seven "prohibited providers" for opiate, amphetamines and other controlled substances, according to audit results released Wednesday.
Auditors found the massive publicly funded health insurance program paid $50,682 for 3,445 claims for prescriptions written by the seven banned providers, according to Auditor Suzanne Bump's office.
Overall, the audit released Wednesday determined that MassHealth paid $476,787 for services or prescriptions from doctors that are disallowed by federal law from participating in the program due to convictions related to patient abuse, health care fraud, and other federal violations.
“In discussions with our colleagues in other states, we learned this is a problem throughout the country so we conducted data analytics to determine whether the problem existed here. That analysis turned up a sufficient level of concern that led us to conduct this audit,” Bump said in a statement. “The inclusion of prohibited providers in the MassHealth program represents a violation of public trust. MassHealth must quickly address this issue in order to ensure the safety of program participants.”
Auditors learned that 12 excluded providers were paid for 5,534 claims for medical services for 1,802 MassHealth members. Most of the claims were made by managed care organizations, the audit said.
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