MassHealth pays nearly $500,000 to banned physicians

A Massachusetts state audit revealed the state's Medicaid program paid nearly half a million dollars to physicians who had been banned by the federal government, according to the Boston Herald.

State Auditor Suzanne Bump told the newspaper that the report exposes flaws in the program run by MassHealth. All told, 12 providers submitted more than 5,500 claims to MassHealth totaling $410,000 in 2013 and 2014, including one physician who collected nearly $170,000. Another nine submitted pharmacy claims for opiates.

MassHealth officials told the Herald that the organization created a workgroup to address concerns. Last June, an audit found MassHealth paid more than $500 million for improper or unnecessary services over the course of five years, a large portion of which were traced back to duplicate claims paid by the insurer's  managed care plans.

Watchdog agencies like the Government Accountability Office have routinely urged the Centers for Medicare & Medicaid Services to improve federally maintained electronic databases that track provider enrollment, pointing to $2.8 million in payments made to 90 excluded providers in 2011. Last year, a Reuters report identified 1,800 physicians who were excluded from Medicare that still billed the agency, including one in five banned physicians who billed Medicaid programs in another state.

To learn more:
- read the Boston Herald article