Boston, MA – State Auditor Suzanne M. Bump announced today that her office, through its Bureau of Special Investigations (BSI), will increase its focus on addressing Personal Care Attendant (PCA) fraud in the Commonwealth. The announcement comes as Bump released the BSI annual report. The report shows that the number of incidents of MassHealth PCA fraud identified by Bump’s office has more than doubled over the past three years, growing from 147 cases in 2016, to 300 cases in 2018, resulting in $1,379,493.93 of fraud. In total during Fiscal Year 2018, Bump’s office identified $14.4 million in public benefits fraud, spread over 922 completed investigations.
“Personal care attendants help people with disabilities maintain their independence and remain in their community. However, our work has shown that this is a public benefit that is unfortunately all-too-frequently ripe for fraud and abuse,” Bump said of the annual report. “Using our powerful data analytic tools and strategic partnerships with other state and local government entities, my office is committed to focusing our efforts in this area to provide taxpayers with confidence that these benefits are reaching the individuals for whom they are intended.”
MassHealth allows members with permanent or chronic disabilities to hire PCAs to help them with personal care and other activities of daily living. Through this program, MassHealth provides the member with funds to hire the attendant and act as their employee. The MassHealth member is responsible for hiring, scheduling, training, and if necessary, firing the PCA.
In the 2018 report, BSI investigated cases in which PCAs defrauded MassHealth by billing the program for services to patients who were in long-term care facilities, which is prohibited. Investigations also found PCAs who did not report earned income and falsely submitted timesheets for services provided to MassHealth members.
The BSI annual reports shows the majority of the fraud found by the office--$8,754,539.01 or 61 percent--was identified in the state’s MassHealth program. During the past year, BSI’s investigations resulted in:
As State Auditor, Bump has made it a priority to strengthen the integrity and accessibility of public assistance programs. Public benefit programs are designed to provide needed assistance to the Commonwealth’s most vulnerable and disadvantaged residents.
The Office of the State Auditor’s Bureau of Special Investigations investigates allegations of public assistance fraud throughout the Commonwealth. Its work ensures taxpayer dollars are used effectively and that benefits are available to residents who truly need and qualify for them. BSI investigates programs administered by DTA, and the Division of Medical Assistance (which administers MassHealth). In addition, BSI has an agreement with the Department of Early Education and Care (EEC) to investigate fraud in that program as well. BSI receives referrals for investigation from its agency partners, public tips, referrals from federal agencies, and through the use of its data analytics tools. The public can report potential fraud to BSI at: https://www.mass.gov/how-to/report-public-benefit-fraud