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Cincinnati Medicaid Provider Overpaid $688,292
Columbus – Citywide Incorporated, a Cincinnati Medicaid provider, was overpaid $688,292 for services it provided because it employed unqualified employees, billed for services that were not properly documented, and used the same documentation to bill for multiple claims.
“Everyone who is involved in the care of Ohioans, including their transportation providers, must be properly trained,” Auditor Dave Yost said. “If you can’t be trusted to meet and document basic requirements, you shouldn’t be entrusted with their care.”
Auditors reviewed personnel files and found Citywide had no drivers that met the qualifications during the examination period from January 1, 2010 through December 31, 2012. In addition, auditors found non-compliance with requirements for both patients and trip documentation. As a result of non-compliance, auditors said the state may recover all $688,292 paid for services on or after July 1, 2010. With interest of $72,379, Citywide Incorporated owes the state $760,671.
The examination reviewed a statistical sample of 1,631 services and found 797 errors in addition to Citywide having ineligible drivers. Auditors “became concerned as to the authenticity of the records submitted” by Citywide, and in testing found the same certificate of medical necessity (CMN) used multiple times with dates of transport and signature dates changed. In addition, the same CMN was used for different recipients with changes to the recipient names and identifiers listed.
Auditors said Citywide declined to sign a letter acknowledging responsibility for maintaining records and complying with applicable laws and regulations regarding Ohio Medicaid reimbursement. The company also failed to provide documentation related to compliance.
Auditors also found:
- 140 ambulette transports in which the amount of mileage paid exceeded the mileage documented;
- Transports with no supporting documentation and without an identified driver;
- Drivers with no or insufficient background checks and those lacking appropriate passenger assistance training;
- Documentation included multiple trip sheets to support the same individual being transported; and
- Some trips provided by drivers outside of their reported hire and termination dates.
A full copy of this report is available online.
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