Home / Health / RI Medicaid Audit: Every Opioid Claim Flawed
RI Medicaid Audit: Every Opioid Claim Flawed
19 Oct
Summary
- Every single Medicaid opioid claim audited had issues.
- State agency oversight failed to consistently flag problems.
- Millions in claims are potentially noncompliant.
A recent state audit of 100 Medicaid claims submitted by opioid treatment providers in Rhode Island over a two-year period revealed significant compliance issues, with every single claim showing at least one problem. The Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), responsible for overseeing these providers, failed to consistently identify these deficiencies despite regular inspections.
The audit, spanning January 2023 through December 2024, identified 1,729 deficiencies across the sampled claims. These included issues with patient assessments, the frequency of treatment plan reviews, and the provision of required counseling sessions accompanying medication-assisted treatment (MAT). While the audit did not find evidence of providers billing for services they did not deliver, the lack of documentation and adherence to regulatory requirements raises concerns.
Separately, the report highlighted an additional 6,347 potentially improper Medicaid claims totaling $875,696, related to incorrect billing for methadone treatments. The Executive Office of Health and Human Services has stated it is reviewing these billing issues and crafting corrective action plans that include recoupments. The BHDDH is also reviewing the audit findings and planning to expand its monitoring efforts, including unannounced inspections and a centralized compliance tracking system.
