MassHealth Spent Nearly $85M on Out-of-State Residents ~ IN YOUR CORNER with STATE AUDITOR DIZOGLIO

Hello Valley Patriot Readers,

Our office has been very busy releasing several audit reports before the end of the fiscal year, while also focusing on approximately 64 ongoing audits.

Most recently, we released an audit of MassHealth, as part of our ongoing independent statutory oversight of the state’s Medicaid program. I want to highlight this audit in particular for readers as an example of how a state agency did not ensure money was being spent appropriately and therefore overpayments were made. Fortunately, our office conducts these audits to properly review this type of misspending and shine a light for MassHealth to make necessary improvements to their processes and procedures moving forward.

Our audit determined that MassHealth made an estimated $84,832,094 in payments to managed care organizations (MCOs) on behalf of individuals living outside of Massachusetts.

In every audit released from our office where there are findings, we also provide recommendations to the auditee. In this audit, our office recommended that MassHealth require sufficient documentation to substantiate residency in Massachusetts. We also recommended that MassHealth investigate and resolve all instances where data shows a member is enrolled in another state’s Medicaid program.

We want our audits to serve as a tool for agencies to help ensure greater transparency and accountability in every area of state government. Due to a lack of appropriate oversight by MassHealth, payments to MCOs were made for far too long on behalf of people enrolled in another state’s/territory’s healthcare program. Our office strongly urges MassHealth to adopt this audit’s recommendations in a timely manner to help prevent an issue of this magnitude from happening again in the future.

To read this audit in its entirety, check it out here:

Our audits will continue to shine a light on state agencies to identify misuse of taxpayer dollars and help ensure a more accountable and transparent state government.

As always, feel free to contact our office anytime via email at or by phone at (617) 727-2075. If you’re ever in the State House, I hope you’ll stop by and visit our team in room 230!
Yours in service,
Diana ◊