MassHealth waste targeted by government officials
Outlining their requests for funding in the next fiscal year, the state's attorney general, auditor and inspector general all asked budget writers on Tuesday for support in combating waste, fraud and inefficiencies in the MassHealth system.
"We think it's very important to protect the integrity of that system," Attorney General Maura Healey said in testimony before the Joint Committee on Ways and Means. "We know how fraud can happen and that it does happen, and I think now, given the additional needs that we're facing and strain on that system, we need to take every step and every measure to be as vigilant as we can."
Healey asked the committee for a 4 percent increase in funding for her office's Medicare Fraud Unit over this year, the same increase proposed by Gov. Charlie Baker in his 2017 fiscal budget.
Auditor Suzanne Bump asked state budget writers to add roughly $757,000 to Baker's recommendation for her office in next year's budget, saying that her office is "an invaluable resource" in identifying and eliminating waste, fraud and abuse, particularly in MassHealth.
Of the requested increase, $711,000 would go toward adding at least one more audit team, fully deploying the office's data analytics capabilities and supporting its career development program, she said.
Bump reminded lawmakers of the additional $300,000 they appropriated to her office last year specifically for the Medicaid audit unit. With that money, she said, her office hired 5.5 new staff members and last June conducted an audit that identified half a billion dollars in improper payments and lost potential savings in MassHealth's managed care program. Bump called it the largest finding in the last 27 years.
"More auditors means more audits. Whereas this unit had seven audits in progress last year at this time, there are currently 15 in progress," Bump said. "And, more audits means more savings."
Those savings, she said, could be especially important given Baker's stated goal of restraining MassHealth spending growth to no more than 5 percent in fiscal 2017, which begins on July 1. Baker recommended a budget of $15.4 billion next year.
"I know you need to keep spending growth in check. In the MassHealth program, the challenge is especially great," the auditor told the budget-writing committees.
If the Legislature sees fit to grant Bump's request, it would boost her office's total appropriation to roughly $19,113,000, the smallest of any constitutional office other than the executive.
"When you consider the annual budget of our agency -- less than $20 million -- and compare it to the impact we have, it is clear that our work improves efficiency and accountability in government spending, and that diminishing our resources is counterproductive," Bump said.
Baker's budget allocates $46,962,000 for Healey's office, including $4.2 million for a Medicaid fraud unit. Seventy-five percent of the Medicare fraud line item is reimbursed by the federal government, Healey said.
Healey described her office as a "revenue generator for the state and its residents," with $18 recovered for every $1 invested. In the 2015 fiscal year, she said, her office recovered $18.4 million in fraudulent Medicaid claims to MassHealth.
In requesting budget language that would authorize his office to continue examining health care spending, Inspector General Glenn Cunha referenced a review by his office that called on MassHealth to improve its payment of claims for some community-based services.
The review found that MassHealth had paid claims for transportation to medical appointments when there was no corresponding claim for a medical appointment itself, paid different home health agencies to provide the same types of services to the same person on the same day, and paid claims for transport to adult day care on days there was no claim for adult day care.
After Tuesday's hearings, House Ways and Means Chairman Rep. Brian Dempsey said the Legislature had committed fund to ensure that benefits are not abused.
"We have committed resources to assist in that work," Dempsey said. "We have supported expansion of that work. I think what you heard today in term of the testimony is that it's effective, that all of them are delivering very very good results. We want to continue to build on that."
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