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Lack of Medical Need Results in 100 percent Rejection of Payments to Medicaid Provider
Columbus – An accelerated two-month audit of Tuba Rescue Transportation, a Hamilton County-based Medicaid provider, resulted in the denial of more than $306,000 in services billed for transportation of Ohio Medicaid patients, according to an report released today by Auditor of State Dave Yost.
Medicaid rules require certificates of medical necessity prior to payments for covered services, such as transportation.
“Taxpayers in Ohio and nationwide are willing to support Medicaid when it is medically necessary,” Auditor Yost said. “The best control we have, sometimes the only control to tell us the need is there, is the doctor’s order.”
Even though the provider confirmed it was aware of Medicaid rules requiring certificates of medical need, no certificates were provided for any of the services rendered during the audit period.
Other citations in the audit included:
- Only two of four drivers employed by the provider were properly certified as required under state law.
- Of 100 dates of services examined by the auditors, 200 instances of failed documentation were found—two for every patient served. Missing information included dates, pick up and drop off locations and times, mileage, driver’s and patient’s names and, in 24 of the 100 instances examined, no documentation at all.
The Auditor of State’s office performs audits of Medicaid providers to ensure compliance with reimbursement rules and to confirm that services billed to Ohio Medicaid are properly documented and consistent with professional standards of care, medical necessity, and sound fiscal, business, or medical practices.
A full copy of this audit can be found online.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,600 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.