Boston — Today the Office of State Auditor Suzanne M. Bump released audits identifying two dental providers charging MassHealth for services with inadequate documentation to support these claims. The charges issued to MassHealth with inadequate documentation had a combined total of over $4.5 million. Additionally, the audits found that both providers were not in compliance with MassHealth regulations. The audits, which examined the period from July 1, 2015 through December 31, 2020, reviewed the offices of Dr. Nicholas Franco of East Boston and Dr. Melissa Hamilton of Taunton.
“MassHealth is a program utilized by the public to ensure all populations have fair and equal access to professional opinions in the medical field. When individuals abuse the system by not doing their due diligence, it diminishes the trust placed in these programs. I hope to see Dr. Franco and Hamilton atone for the issues here and work with MassHealth to repay the claims that lack documentation or find a commendable solution for the public,” said State Auditor Suzanne M. Bump.
The audit of Dr. Franco found inadequate documentation to support at least $2,528,147 in dental claims. The audit was initiated after the Office of the State Auditor (OSA) Bureau of Special Investigations (BSI) conducted data analytics based on Dr. Franco’s claims that identified potential improper payments.
Similarly, Dr. Hamilton had inadequate documentation to support at least $2,063,481 in dental claims. The audit of Dr. Hamilton’s office was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program.
Both audits recommend that the individual dentists collaborate with MassHealth to determine how much of the unallowable dental claims should be repaid. It is also recommended that each office establish policies and procedures according to MassHealth regulations to ensure all claims are properly documented for any future work that is done.
A PDF of the Audit Report – Office of Medicaid (MassHealth) Review of Claims Submitted by Dr. Melissa Hamilton is available here.
A PDF of the Audit Report – Office of Medicaid (MassHealth) Review of Claims Submitted by Dr. Nicholas Franco is available here.