Medicaid Transportation Company Owes State $186,555
Columbus – A Medicaid transportation company based in Lucas County billed the state for hundreds of services that lacked proper supporting documentation, according to a Medicaid examination released today by Auditor of State Dave Yost.
The review found Citywide Medical Transportation, LLC was overpaid by $182,381 – more than 84 percent of the $215,908 it received from the state from February 2013 through December 2014. With interest, the provider owes the Ohio Department of Medicaid $186,555.
Auditors tested 368 attendant services and found no documentation to support any of them. In a separate sample of 856 wheelchair van services, auditors identified 1,138 errors, including 412 related to certificates of medical necessity, which are required for service authorization.
A total of 292 certificates did not certify the recipients met any criteria for medical necessity, did not include a medical condition and/or were not signed by an authorized practitioner. One certificate was apparently completed by a patient with a handwritten note reading, “I don’t have any medical condition that requires me to use an ambulette. Transportation is a problem getting to doctor appointments. I don’t feel like waiting for a bus.”
Such a transport does not come close to satisfying the requirements for a Medicaid reimbursement, Auditor Yost said.
“I’m pretty sure impatience isn’t a diagnosable medical condition,” he said. “The fact that this provider thought otherwise makes it clear that they either didn’t know the rules or chose not to follow them.”
Auditors noted another 142 errors related to driver qualifications, including 59 transports provided by a driver with no criminal background check, signed physician statement, alcohol test, first aid certification or annual driving record for 2014.
In addition, a review of trip documentation for wheelchair van services discovered overpayments stemming from the following 150 errors:
- 73 transports with no trip documentation;
- 40 transports for which it could not be determined if one point was to a Medicaid covered service;
- 25 transports in which the miles billed exceeded the miles documented; and
- 12 transports where neither point was to a Medicaid covered service.
The examination also determined that 12 wheelchair van services were provided with a vehicle prior to its licensure, and the documentation for 85 services did not identify the vehicle used.
A full copy of this report is available online.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.