Ambulance Service, Inc. Owes Ohio Medicaid $82,500
Columbus – Ambulance Service, Inc. (Jefferson County) billed for services that lacked proper documentation and hired two drivers who had no first aid and/or CPR certification prior to rendering services, according to an audit released today by Auditor of State Dave Yost.
“Complete and accurate documentation is essential both for the patient and the taxpayer,” Auditor Yost said. “Ambulance Service, Inc. has some serious work to do.”
Auditors reviewed 1,517 paid transports provided during the period of January 1, 2010 through December 31, 2012 and identified 1,221 errors, which resulted in overpayments totaling $76,126. With interest in the amount of $6,398.76, Ambulance Service, Inc. owes the Ohio Department of Medicaid $82,524.76, according to the report.
The audit identified 493 paid transports in which the certificates of medical necessity (CMN) did not certify that the recipients met any criteria for an ambulette transport, did not include a medical condition that necessitated the level of transport or were not signed by an authorized practitioner. In some cases, the credentials of the signer could not be verified. Additionally, auditors determined that the CMNs for 36 transports were copies of prior CMNs with altered signature dates and certification periods.
Auditors also noted 41 instances in which there were no CMNs to cover transports, and 425 transports with CMNs that included medical conditions and were signed by authorized practitioners, but were not complete.
Testing of trip documentation found 193 exceptions, which include:
- 167 transports in which the mileage billed exceeded the mileage noted on the service documentation;
- 22 transports with no service documentation;
- 2 transports in which the service documentation was marked “canceled,” but the required documentation was not provided; and
- 2 transports in which the name and address of the Medicaid-covered service were missing, therefore, auditors could not determine if either point of transport was to a Medicaid-covered service.
Auditors also determined that two transports provided on one date were rendered in an ambulette that was not licensed by the Ohio Medical Transportation Board.
A review of the personnel files for three drivers whose hire dates fell within the examination period found that two did not have first aid and/or CPR certification, and one did not have passenger assistance training before providing services. One driver also had CPR certification before rendering services, but later had a one-month lapse in the certification. Additionally, none of the three drivers had any documentation of alcohol testing.
A full copy of this report may be accessed online.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,800 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.