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Ineligible Drivers, Missing Documentation Cited in Medicaid Examination
Columbus – Transportation services provided by ineligible drivers and a lack of required documentation contributed to more than $300,000 in Medicaid overpayments to a provider located in Cuyahoga County, according to a report released today by Auditor of State Dave Yost.
The review of DSquare Transportation Ltd. found 1,217 errors among 2,586 services provided from Jan. 1, 2012 through Dec. 31, 2014. Those errors resulted in overpayments totaling $303,349 – nearly three-fourths of the $418,924 reimbursed by the Ohio Department of Medicaid (ODM) during the period. With $13,559 in interest, the provider owes ODM $316,908.
Auditors discovered one of the provider’s two drivers lacked first aid certification for the first 31 months of the examination period. Additionally, the first aid certificate ultimately obtained by the driver was from a self-guided online course that did not meet Medicaid requirements. The second driver had lapses in both first aid and CPR certifications spanning three months in one instance and two weeks in another. Auditors noted a total of 808 services provided by drivers when they were ineligible due to lapses in certification.
“These requirements help ensure the safety of patients during transport,” Auditor Yost said. “If a company isn’t capable of doing that, it should find something else to do.”
During a review of certificates of medical necessity (CMN), which are required for service authorization, auditors identified 193 errors that resulted in overpayments. These included 119 services with no CMNs to cover the transports and another 74 instances where the CMNs did not certify that recipients met any criteria for medical necessity, did not include a medical condition that supported the need for the transport, and/or were not signed by an authorized practitioner.
Auditors also discovered overpayments stemming from 78 errors in trip documentation, including 41 transports with no documentation to support the mileage billed. In another 18 cases, auditors could not determine if one point of the transport was to a Medicaid-covered service.
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.