MassHealth, Massachusetts' Medicaid program, made about $93 million in improper payments for behavioral health services over five years, according to an audit report released Monday.
The audit, conducted by state auditor Suzanne Bump, found the state failed to bill the Massachusetts Behavioral Health partnership for about $93 million in claims from July 2010 to June 2015. The report also questioned about $100 million in claims and recommended MassHealth review them.
Under state law, MassHealth should bill some mental health services to the Massachusetts Behavioral Health Partnership, a managed care organization that provides such services to a portion of Medicaid beneficiaries.
The partnership serves more than 375,000 of MassHealth's 1.9 million beneficiaries. In total, MassHealth paid about $2.6 billion for members who are enrolled in the Massachusetts Behavioral Health Partnership.
The audit identified several reasons improper billing occurred including insufficient system processes to identify Massachusetts Behavioral Health Partnership enrollees as well as improper coding and duplicative payments.
A MassHealth spokesperson said the state agency disagreed with the auditor's findings because they "don't recognize the important distinction between behavioral health and medical services delivered to individuals with behavioral health conditions." MassHealth said that the audit mistakenly includes services like flu shots as behavioral health services covered by Massachusetts Behavioral Health Partnership because the patient is an enrollee.
The report's findings were similar to a 2015 audit from Bump's office that found MassHealth failed to bill managed care organizations for approximately $233 million in services.
In a conference call with reporters, Bump said the state is struggling to fund MassHealth, which has a $16 billion budget. Identifying ways to stop improper billing is a way to open up revenue, she said.
"It is imperative (MassHealth) gets a handle on this program," she said.
