Quality Assurance and Provider Review

The MassHealth agency conducts reviews of providers and administers quality-control programs to ensure that MassHealth members are receiving high-quality medical services. An independent clinical laboratory must maintain its own quality-control program and successfully participate in one or more proficiency testing programs that cover all Medicare-certified specialties and subspecialties of the laboratory. The laboratory must make the results of the proficiency testing programs available to the MassHealth agency and the Attorney General’s Medicaid Fraud Division upon request or during an on-site visit.