Taylor: Scioto County Medicaid Provider Owes State More Than $430,000

Thursday, May 21, 2009

Scioto County -

Auditor of State Mary Taylor today released the audit of Life Ambulance Services, Inc. and announced that the Portsmouth-based Medicaid service provider owes the state more than $430,000.

The report finds that the ambulance company, which also provides transportation to wheelchair-bound patients by ambulette, submitted inappropriate and erroneous claims to the state’s Medicaid program for reimbursement.  As is standard practice for all Medicaid provider audits, Taylor is forwarding her report to the Ohio Attorney General’s Medicaid Fraud Control Unit for further review.

“I will not tolerate the waste and abuse of public tax dollars,” said Taylor. “Medicaid providers who take advantage of the state’s billing system and fail to follow state law will be held accountable.”

Taylor’s office tested more than 120,000 separate services submitted for reimbursement by Life Ambulance during a three year period – April 1, 2003 to March 31, 2006. From a total of nearly $4.8 million in claims, the audit identifies $352,663.83 in improper claims submissions as well as $81,779.36 in interest owed to the state.

The audit reveals that several claims filed by Life Ambulance for reimbursement were inappropriate and likely the result of poor recordkeeping and management practices. Problems identified include:

  • Claims lacking any supporting documentation that the service was ever provided
  • Ambulance services billed to Medicaid that should have been billed to Medicare
  • Duplicate claims submitted for the same patient on the same date for the same destination
  • Claims billed for mileage greater than that supported by documentation

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 only 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 Medicaid program. Medicaid is currently the largest program in state government.

Taylor continues to call upon state policymakers to implement the recommendations outlined in a comprehensive performance audit of Medicaid released in 2006. In December 2008, 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 reveals more than $300 million in potential annual saving recommendations that have not been implemented.

A copy of the complete audit is available online at www.auditor.state.oh.us.