Mass Gets Tough on Fraud

Joining the chorus of many other states throughout the country, Massachusetts Governor Charlie Baker has announced under his direction, home health agencies are going to be put under review.  Starting with the 2017 budget and to curb what is seen as rampant abuse of Medicaid home care services, new restrictions are being proposed.


Like many other states, Medicaid beneficiaries are now being moved from a traditional buffet of services with essentially taxpayer funded, unlimited care to a more restrictive model. The model is based on traditional insurance models in which MassHealth (Mass’ Medicaid program) members would be forced to choose a managed care plan.  Choosing such a plan would restrict MassHealth beneficiaries from changing plans for a full year.


These changes are part of an ongoing plan to turn MassHealth into a tighter run program and squeeze out what has been known to many providers for quite a long time as rampant abuse by its peers.  Starting last year, the governor instructed MassHealth to verify eligibility of beneficiaries and as a result, 250,000 people were removed.  It should be noted that Governor Baker has very deep knowledge of healthcare in Massachusetts and the United States in general.  He served for many years under two prior governors as the Secretary of Health and Human Services before becoming the CEO of Harvard Pilgrim Healthcare, one of the state’s largest independent health insurers.


Additionally, Massachusetts is joining many other states in implementing a moratorium on new agencies.  We are still awaiting more information on the moratorium as the official language is vague and seems to comingle certified home health agencies and private duty home care agencies which have never been required to be licensed in Massachusetts.  Stay tuned to see how Massachusetts copes with changes that, in the past, favored spending taxpayer money without legitimate systems of checks and balances.