Taylor Audit Exposes More Than $308,000 Improperly Billed by Circleville Medicaid Provider

Tuesday, October 7, 2008

Circleville -

Auditor of State Mary Taylor today released the Medicaid provider audit of Pickaway Plains Ambulance Service, Inc.  The audit reveals that the Circleville medical transportation provider may owe the Ohio Department of Job and Family Services (ODJFS) $308,822.09 for improperly billed Medicaid services and $62,475.13 in accrued interest. 

“Medicaid providers in the state must be held accountable for the public money they spend,” Taylor said.  “My office will continue to look for ways to improve the program’s efficiency and effectiveness, while ensuring providers are not wasting or abusing the taxpayers’ money.” 

The audit reviews Medicaid services billed to ODJFS from January 1, 2003 through December 31, 2005.  The audit shows that Pickaway Plains Ambulance Service, Inc. improperly billed Medicaid $308,822.09 for ambulance and ambulette transportation services during the two-year audit period.  Furthermore, the provider failed to comply with various Medicaid rules, resulting in overpayments.  Some of the more notable practices that led to the overpayments include:

• Billing for transportation services that are not covered by Medicaid.
• Incorrectly billing ambulette services as ambulance services, which are paid at a higher rate.
• Charging for services twice when only one service was performed.
• Billing for services that did not have the necessary supporting documentation, including missing or incomplete Certificates of Medical Necessity (CMN).  CMNs are the transportation equivalent of a doctor’s prescription and ensure that the transports provided are for a medically necessary purpose.
• Billing for transports longer than 50 miles without appropriate justification. The Medicaid program requires that providers document a reason for taking a patient out of their community.
• Billing transportation services with overstated mileage.
• Separately billing Medicare and Medicaid as primary insurers for the same transports for those patients who are eligible under both systems.
• Billing Medicaid for Medicare-covered services.  By regulation, Medicaid is designated as the payor of last resort.

In 2005, as a member of the Ohio House of Representatives, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor discretionary authority to audit individual Medicaid providers.  Medicaid provides health coverage to families with low incomes, children, pregnant women, and people who are aged, blind or have disabilities. 

Taylor has referred the findings to ODJFS. As the state agency charged with administering the Medicaid program in Ohio, it is the responsibility of ODJFS to make any final determinations regarding recovery. 

A full copy of the report is available online at www.auditor.state.oh.us.