Taylor: Cincinnati Medicaid Provider Owes State More Than $680,000

Thursday, February 19, 2009

Cincinnati -

Auditor of State Mary Taylor today released the audit of Hometowne Transportation, LLC and announced that the Cincinnati-based Medicaid service provider owes the state more than $680,000.

The report finds that the ambulette company, which provides transportation to wheelchair-bound patients, submitted inappropriate and potentially fraudulent claims to the state’s Medicaid program for reimbursement. Taylor is forwarding her report to the Ohio Attorney General’s Medicaid Fraud Control Unit for further review.

“I will not tolerate the fraud, waste and abuse of public tax dollars,” said Taylor. “Medicaid providers who take advantage of the state’s outdated billing system and fail to follow state law will be held accountable. When my office identifies Medicaid providers who commit fraud, we will do everything we can to ensure they no longer do business with the state of Ohio.”

Taylor’s office tested more than 20,000 separate reimbursement claims submitted by Hometowne during a three year period – April 1, 2003 to March 31, 2006. From a total of nearly $1.3 million in claims, the audit identifies $565,088 in improper submissions as well as $119,767 in interest owed to the state.

Auditors identified 5,443 claims in which Hometowne Transportation improperly billed the state for “attendant services.” Essentially, the provider was billing Medicaid for family members, friends or nursing home aides traveling with the patient as if they were additional employees of Hometowne.

Other inappropriate and potentially fraudulent claims submitted to the state include:

• Duplicate claims – identical claims submitted for identical services conducted on identical dates
• Improperly billed mileage – claims submitted where the mileage billed exceeded the provider’s own odometer readings
• Billing for services after the date a patient had died – claims dated for services said to have been provided after the date of a patient’s death

Taylor’s review of Hometowne also included a thorough review of employee files to determine compliance with driver and vehicle requirements outlined in state law.

The audit indicates that some employees lacked:

• Required medical training such as CPR certificates
• Criminal background checks
• Periodic reviews of driving records

The failure of transportation providers to comply with state law places patients in harm’s way and could jeopardize Hometowne’s status with the Medicaid program as a provider.

In 2005, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor discretionary authority to audit individual Medicaid providers.  Prior to that, Medicaid providers were audited at the request of the Ohio Department of Job and Family Services.

Medicaid provider audits are a component of Taylor’s comprehensive approach to improving the efficiency and effectiveness of Ohio’s $13 billion Medicaid program. Medicaid consumes 37 percent of the state budget – more than any other taxpayer funded government program.

Taylor continues to call upon state policymakers to implement the recommendations outlined in a comprehensive performance audit of Medicaid released in 2006. In December, she released an update to the Medicaid performance audit that shows the state’s Medicaid program remains a complex and costly bureaucracy. The follow-up revealed more than $300 million in potential annual savings that remains left on the table.

A copy of the complete audit is available online at http://www.auditor.state.oh.us/AuditSearch/Reports/2009/A_9_Hometowne_Final_Report_020309.pdf.