Salem News: The Massachusetts inspector general is investigating the state’s Medicaid program, which is paying tens of millions of dollars for sleep studies, according to a report.
The report released Friday by Inspector General Glenn Cunha’s office said nearly 58,000 claims were submitted by providers to MassHealth for sleep apnea studies between Jan. 1, 2015 and Dec. 31, 2019, totaling more than $25 million.
Of those, 1,286 claims totaling $557,103 only billed MassHealth for the first half of the two-part sleep studies and lacked a professional review and diagnosis from a physician.
That suggests providers are either “wasting taxpayer money” with unnecessarily procedures or “defrauding MassHealth by billing for sleep studies they did not perform,” the report’s authors wrote.
“Billing for the technical component without the professional component is a red flag for fraud, waste and abuse,” the report stated. Another possibility is that providers are performing full sleep studies but failing to bill MassHealth for professional reviews, the report noted.