Purpose

To determine whether Medicaid made inappropriate payments to a transportation provider. The audit covered the period from September 26, 2012 to December 31, 2016.

Background

Medicaid provides transportation to medically necessary services for those recipients who are unable to obtain transportation on their own. Medicaid reimbursement for medically necessary transportation of Medicaid recipients is available to lawfully authorized transportation providers. Participation in Medicaid requires that providers agree to prepare and maintain contemporaneous, complete, acceptable, and verifiable records necessary to support services furnished and payments received from Medicaid for a period of six years from the date the care, services, or supplies were furnished or billed, whichever is later. Providers are required to readily have records accessible for authorized officials for audit purposes. If any of the required information is incomplete, or deemed unacceptable or false, any relevant Medicaid payments will be recouped and the provider may be subject to additional fines and sanctions.

The provider we reviewed is a private proprietary corporation that has been providing taxi services to Medicaid recipients since September 2012. During the period from September 26, 2012 to December 31, 2016, Medicaid paid the provider $2.4 million for 26,345 transportation claims.

Key Finding

The provider did not maintain the required documentation to support transportation claims for the period September 26, 2012 to December 31, 2015, which accounted for $1.4 million in inappropriate Medicaid payments to the provider.

Key Recommendation

Review the $1.4 million in Medicaid payments to the provider and recover any inappropriate payments, as warranted.

Other Related Audit/Report of Interest

Department of Health: Appropriateness of Payments to Transportation Management Contractors and Providers (2016-S-67)