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The Commonweath of Massachusetts Office of Medicaid (MassHealth) has announced that they will be conducting audits of HME providers. These audits began in January 2019.

The audits are a result of a report published in April 2017 by MassHealth on a "Review of Claims for Durable Medical Equipment". In the report, MassHealth determined $206,000 in improper payments were made to DME Suppliers for equipment provided to MassHealth members. The overpayments represented a variety of claims from wheelchair accessories to parenteral and enteral nutrition.

The audits currently underway are being conducted by Optum and MassHealth Office of Long Term Support and Services. MassHealth anticipates conducting two audits per month until all HME companies have been audited. Results from the audit may take up to six months.

What can you expect?

  • Suppliers will receive a phone call the day before the audit, followed by an email (Audits can be rescheduled if key staff members are not available)
  • 100 patient claims will be reviewed
  • Appropriate licenses and employee records will be requested
  • Documentation not available at the time of the audit can be submitted at a later date
  • If the supplier disagrees with the audit findings, they can appeal

If you are experiencing Medicaid audits and would like assistance - we can help! Let our team of clinical experts review your files and ensure that coverage criteria has been met. Don't wait for the auditor to find the issues!

For more information, Contact Us today!