BOSTON — Service providers who work with children diagnosed with autism “overbilled” the state’s Medicaid program by nearly $17.3 million in the previous fiscal year, according to a new report by the Inspector General’s office.
The investigation by Inspector General Jeffrey Shapiro uncovered $16.7 million of improper payments through MassHealth’s Applied Behavior Analysis program — dating from Jan. 1, 2022, to Oct. 30, 2023 — for supervised care of patients.
The program, which provides treatment to low-income children with autism spectrum disorder, requires that for every 10 hours of services provided by behavioral technicians and interns, there must be at least one hour of supervision by a licensed applied behavior analyst. The IG’s report said some providers billed MassHealth for supervisory services that exceeded that ratio.
Shapiro’s review also found that MassHealth made nearly $440,000 in payments to providers that included “impossible billing” for 24 hours of continuous service.
MassHealth paid at least 561 service claims from more than 300 members for work on holidays, including Christmas Day, New Year’s Day and July 4, during the period covered by the investigation, totaling nearly $163,000, the IG’s report noted.
In a statement, Shapiro said the state agency’s failure to ensure that autism services are properly supervised “undermines the reliance that families place in MassHealth to deliver the highest quality of services for their children.”
“It is equally concerning that ABA service providers billed for services that did not meet MassHealth’s supervision standard, resulting in a lower level of service for children with ASD who are on MassHealth,” he said. “That is unacceptable.”
Shapiro also reviewed MassHealth’s oversight and internal controls to identify, prevent and recover improper payments. He said the review found that MassHealth contracts contain financial incentives for service providers to set robust controls to mitigate and identify fraud waste and abuse.
He said the review was “critical because it is estimated that millions of dollars are lost yearly to fraud, waste and abuse in the MassHealth program.”
“Such loss of public funds diverts necessary dollars from essential healthcare services,” he said.
Shapiro said his review also found a lack of qualified behavior analysts to supervise the services provided to children with autism. He said the labor shortage is part of a broader problem affecting most sectors of the state’s healthcare system — one that MassHealth can’t solve on its own.
The report recommends the state expand taxpayer-funded loan forgiveness programs to help attract and retain more people to work in health care.
“Still, in spite of the shortage, failure to follow supervisory standards is unacceptable,” he said.
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at [email protected]
By Christian M. Wade | Statehouse Reporter
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