MassHealth Overpayments

Attached are excerpts from the State Auditor's FY 2023 BSI Annual Report in which it explains that CMS prohibits collection of overpayments from beneficiaries (except in limited circumstances) and that pursuant to this directive, the BSI has suspended civil collection of beneficiary overpayments and returned pending collection cases to the MassHealth agency. 

Also attached are comments MLRI submitted to MassHealth in Jan 2023 on proposed rules regarding the collection of overpayments in the premium assistance program in which we analyze the limited state authority to collect overpayments from beneficiaries based on federal law and guidance from CMS. Our comments did not convince the agency to amend its overpayment regulation, but according to the Auditor's report MassHealth has in fact changed its practices as of May 2023. 

Update: Attached is a Dec 2024 letter from CMS to State Medicaid Directors laying out the specific limitations on recovery of overpayments from beneficiaries in the absence of fraud or abuse and and the procedural protections applicable prior to a finding of abuse.