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Government Auditors

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Massachusetts’s State Auditor recently audited the behavioral health program at MassHealth. The audit found that MassHealth paid doctors directly for providing mental health services that should have been paid for by the Massachusetts Behavior Health Partnership (MBHP). MassHealth pays MBHP to manage the coordination of care for mental health services for MassHealth members. The audit found that MassHealth’s payments over a five year period have resulted in roughly $193 million in improper payments. The State Auditor called for an immediate improvement in processes to prevent any further improper payments, and determine whether it can recoup any monies paid.

MassHealth contracted with MBHP to provide fixed-fee behavioral-health and substance-abuse care for certain MassHealth members. The contract covered the services for which direct payments were made to doctors, totaling $93 million. In addition, there were approximately $100 million in questionable payments for family therapy sessions, behavioral-health counseling, psychological testing, and other services. These services are behavioral in nature, but not specifically included in the list of services covered by MassHealth’s contract with MBHP. The audit further found that MassHealth paid claims for behavioral health services provided in emergency rooms, rather than referring them to MBHP, as required by MassHealth regulations.

In a previous 2015 audit, the State Auditor found similar deficiencies in MassHealth’s administration of managed care organizations (MCO) and related contracts. Similar to the contract with MBHP, MassHealth pays MCOs a fixed-fee to cover the costs of a range of medical services for select MassHealth members. The State Auditor found MassHealth paid roughly $233 million to doctors for services that should have been covered under MCO contracts. In addition, it found that the agency could have additionally saved up to $288 million if its MCO contracts had specifically outlined which services would be paid for under the contract.

The Massachusetts auditor report can be found at:

http://www.mass.gov/auditor/news-and-updates/press-releases-2017/audit-finds-almost-193-million-in-improper-or-question.html.

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