SalemNews.com, Salem, MA

Opinion

October 23, 2012

Our view: Fear of barriers leaves MassHealth open to fraud

Once again, a state program aimed at helping the less fortunate has been exposed as a fraud free-for-all.

MassHealth is the Bay State’s version of Medicaid. State Auditor Suzanne Bump released an audit of MassHealth that found the program is losing millions of dollars to fraud.

That should be a warning to the rest of the nation. The Affordable Care Act, better known as “Obamacare,” is expected to funnel millions of the nation’s citizens into their states’ Medicaid plans. The level of fraud found here could be magnified across the country.

Thousands of out-of-state residents could be taking advantage of the program to provide health care benefits to low- and moderate-income individuals living in Massachusetts, according to the report.

Bump’s audit found that MassHealth fails to verify the residency of benefits recipients. The audit also found that others may be receiving benefits while not meeting income qualifications, the State House News Service reported.

The failure to maintain eligibility standards could be costing the state millions. MassHealth is an enormous program serving 1.3 million enrollees — or about 1 in 5 Massachusetts residents. In fiscal year 2011, the program paid health care providers more than $12.2 billion, of which 35 percent came from state funds. The program’s costs are growing on average 8.7 percent annually, Bump’s audit found.

Bump’s office found that MassHealth does not verify an applicant’s state residency, relying solely on self-declaration, the State House News Service reported. MassHealth only checks someone’s address when there are conflicts in an applicant’s information. The policy leaves MassHealth vulnerable to fraud, according to the auditor’s report.

Given MassHealth’s weak eligibility standards, fraud is inevitable.

In 2010, MassHealth spent approximately $6.5 million on services for 4,643 individuals who were later removed from the program because they were not Massachusetts residents, received benefits from another state, or state officials could not determine where the enrollees lived, the news service reported.

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