Auditor’s report finds MassHealth over paid nursing facilities

The audit concludes that MassHealth overpaid approximately $1 million to nursing facilities for room and board.

BOSTON, Mass. (WWLP) – MassHealth did not recover $639,445 of over payments to nursing facilities, according to a report from State Auditor Suzanne Bump.

An audit of MassHealth’s payment of claims submitted by nursing facilities covered the period January 1, 2010 through June 30, 2015.The purpose of this audit was to determine whether MassHealth properly paid nursing facilities for room and board provided to members.Past audits have found problems in MassHealth’s claim-processing system, which resulted in millions of dollars of unallowable and potentially fraudulent claim payments.

In addition to not recovering over payments, the audit found that MassHealth did not ensure that records of members’ care levels were updated promptly in its Medicaid Management Information System (MMIS); MassHealth did not update the specific claim information in MMIS for approximately $3-million of recoupments from nursing facilities; and MassHealth granted MMIS access privileges to staff members without proper documentation.

You can read the auditor’s report here.