EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
2024-034
Medicaid Cluster, COVID-19 – Medicaid Cluster - Assistance Listing No. 93.775, 93.777, 93.778
Recommendation: The Department should enhance its procedures and internal controls to ensure it properly monitors high-risk providers and that it maint...
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
2024-034
Medicaid Cluster, COVID-19 – Medicaid Cluster - Assistance Listing No. 93.775, 93.777, 93.778
Recommendation: The Department should enhance its procedures and internal controls to ensure it properly monitors high-risk providers and that it maintains documentation that claims are paid only to eligible providers.
Action taken in response to finding: Providers who are identified as high risk, are sent for fingerprinting. Once the fingerprinting results are received, they are scheduled for a site visit.
Business Support Services have reinforced with staff that the site visit must follow the fingerprinting results.
Additionally, a checklist will be created for all high-risk providers to ensure that all required steps in the process are completed at enrollment, revalidation or when they are identified as having a credible allegation of fraud or appropriate overpayment.
Name(s) of the contact person(s) responsible for corrective action:
Janice Wadsworth, MassHealth Director Provider Operations
Keith West, Director Special Projects Business Support Services and
Chris Silva, Manager Provider Enrollment Business Support Services.
Planned completion date for corrective action plan: The checklist will be complete by July 2025.