Massachusetts Medicaid program MassHealth may be losing millions of dollars due to overuse of advanced imaging services, according to State Auditor Joe DeNucci.
DeNucci issued a report on September 1 that detailed two reasons for the state's Medicaid imaging cost increases, including a lack physician self-referral regulation and the fact that the Massachusetts Medicaid reimbursement rate for advanced imaging services is higher than that used by the federal government for Medicare patients.
Despite the federal Stark law, intended to discourage physician self-referral for advanced imaging services, Massachusetts does not regulate this practice. And although the federal government has reduced its rate of reimbursement to Medicare providers in recent years, MassHealth has had a net increase in reimbursement rates for imaging services; in fact, DeNucci reported, the state's Division of Health Care Finance and Policy sets reimbursement rates using a different methodology.
Massachusetts could have saved more than $8.5 million in Medicaid payments during fiscal years 2007 through 2009 for Medicaid consumers who also receive imaging services through Medicare, according to DeNucci. He recommended that MassHealth and the Division of Health Care Finance and Policy evaluate their methodologies and begin to match reimbursement rates to federal government levels.
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