A new audit out of the Office of the Auditor General landed this week with a finding that should concern anyone who has a loved one in treatment, or who pays attention to how Rhode Island spends its Medicaid dollars. Every single one of 100 sampled opioid treatment services billed to Medicaid failed to meet at least one state or federal requirement. The audit also flagged $875,696 in potential overpayments tied to how methadone treatment was billed.
As a reporter who lives here and writes for neighbors rather than visitors passing through, this is the kind of story that matters because it touches people many of us know. Opioid treatment programs are a lifeline for families across the state, and this audit raises real questions about whether the paperwork behind that care is keeping pace with the need.
Auditor General David A. Bergantino's office worked with the Boston branch of the U.S. Department of Health and Human Services Office of Inspector General to examine claims from January 1, 2023 through December 31, 2024. The review covered all five opioid treatment providers billing Rhode Island Medicaid, operating across 14 locations. From a pool of 274,412 services worth over $25.5 million, investigators pulled a random sample of 100 for close review.
What they found was a pattern of missing documentation across core elements of care. Auditors counted 95 instances involving intake or five-year biopsychosocial assessments, 75 involving six-month treatment plan reviews, and 70 involving required counseling. Annual reviews, medical exams and toxicology screens also showed gaps, with 99 instances of noncompliance tied to medication-assisted treatment requirements overall. Progress notes and care coordination were bright spots, each showing 95% compliance.
Separately, auditors validated 6,347 claims where Medicaid paid for daily methadone encounters under a billing code meant for weekly bundled claims, sometimes five to seven times in a single week for the same patient.
What it means for residents
For Rhode Islanders in treatment or supporting someone who is, the audit does not say anyone was denied care. But it does say the records meant to track that care, from assessments to drug testing, often were not kept as required. Auditors warn that gaps like these can weaken continuity of care and raise clinical risk.
Both BHDDH and EOHHS responded with plans including self-audits, unannounced visits, staff training and billing manual updates, though no completion dates were given.
As of October 8, no hearing or repayment deadline had been scheduled. Residents can read the full report on the Office of the Auditor General's website or call 401-222-2435.
Source: Uprise RI
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