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State auditor says MassHealth made nearly $1 million in improper payments for medication

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MassHealth made nearly $1 million in improper payments for medications during a two-year period that ended in 2017, according to state Auditor Suzanne Bump’s office.

The program issued payments for 43.5 million medications made between Jan. 1, 2015, and June 30, 2017 — and 25,144 were improperly paid for varying reasons, Bump’s office said on Thursday.

In the statement, Bump’s office said that MassHealth:

■  Paid $300,863 for prescription drug refills that should not have been provided. In one case, a patient whose doctors ordered a one-time prescription for amphetamines was improperly given two 30-day refills, allowing the patient to get a 90-day supply.

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■  Paid $526,229 for emergency refills that were not supposed to be issued. MassHealth authorizes pharmacies to fill prescriptions on an emergency basis when a client loses their prescription. But, Bump’s office found, MassHealth violated its own regulations and repeatedly paid for emergency refills.

■  Paid $155,443 to pharmacies for over-the-counter drugs supplied to members living in nursing homes or skilled nursing facilities. MassHealth regulations prohibit it from paying for these prescriptions for members residing in these facilities.

Bump cited the MassHealth system known as the Pharmacy Online Processing System as the problem, saying it does not have systems in place to identify and reject the flawed claims.

In a response to Bump’s audit, MassHealth officials wrote that they do “not agree with this finding” and are convinced that a “substantial number of the claims identified in this finding were appropriately paid.”

MassHealth said software that was in use during the audit period had some flaws that led to mistakes made in the tracking of prescriptions — and those issues have since been corrected.


John R. Ellement can be reached at ellement@globe.com. Follow him on Twitter @JREbosglobe.