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State Auditor Finds Shortcomings in Commonwealth's MassHealth System

A recent audit of the MassHealth system has found the system open to fraud with thousands ineligible individuals receiving healthcare benefits from Massachusetts. WAMC’s Berkshire Bureau Chief Lucas Willard reports…

Massachusetts State Auditor Suzanne Bump released a report yesterday that pointed out shortcomings in the MassHealth system, which included failures of the state office of Medicaid to verify the incomes and residency of individuals who received tax-payer funded health care benefits.

The audit found that MassHealth has not put together an adequate method of determining state residency of applicants. For this, Bump recommended individuals provide statement of residency, alongside standing residency information. The audit found that in 2010, almost $6.5 million in health care services were provided to 4,643 non-state residents. Bump also found that the MassHealth does not always investigate claims with conflicting income status, and that almost $12 million went to temporary state residents including those on medical visas. That is not in compliance with federal standards.

Auditor Bump says that the oversight in the MassHealth program opens the door to fraud.

House Minority Leader, Republican State Representative Bradley Jones, said that although the percentage of misuse over the entire Medicaid budget is small, the dollars that could be saved are vital other important state programs.

Dr. Harris Julian, Medicaid Director for Massachusetts, said that his office is taking steps to resolve the issues pointed out by the Auditor, and will continue working on improving things such as recommendations for their integrated eligibility system. Dr. Harris said that the Office of Medicaid works closely with the Auditor and State Attorney General to identify and act on fraud, but will also be having further conversations ahead.

The group Health Care For All said that any changes made to MassHealth’s system of residency verification should keep the homeless and disadvantaged in mind. Executive Director Amy Whitcomb Slemmer…

Suzanne Bump says that there are ways that the disadvantaged state residents can declare their residency.

Lucas Willard is a news reporter and host at WAMC Northeast Public Radio, which he joined in 2011. He produces and hosts The Best of Our Knowledge and WAMC Listening Party.
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