The state health agency failed to properly oversee an $18 million-a-year program that provides nonemergency medical transportation to Medicaid recipients, a legislative audit report released Monday concluded.
The report marked the seventh time the state Department of Health and Hospitals received audit findings that could result in improper payments because of lax oversight.
The performance audit found little-to-no monitoring to ensure the rides were medically necessary or even occurred at all in the program, which has been cited as prime for abuse and resulted in people being jailed.
The program provides Medicaid recipients with transportation to and from doctors’ office, out-patients clinics and the like. Nonambulance providers, such as not-for-profits, friends and family can be used, or ambulance providers can be used, if a medical professional deems it is required.
Beginning Dec. 1, the five private insurance companies managing the health care of more than 1 million Medicaid recipients took over the non-emergency medical transportation program.
In a letter responding to the audit, state Medicaid director Ruth Kennedy assured Legislative Auditor Daryl Purpera the companies are contractually obligated to “safeguard Medicaid funds against unnecessary or inappropriate use of services.” In addition, Kennedy said, Medicaid staff will oversee and monitor the insurance companies for compliance.
Payments the auditor said may have been made in non-compliance with program rules will be reviewed by DHH and decisions made on recovery by July 1, 2016.
“They are really going to have to hold the managed care organizations accountable to do the things we are recommending in the report,” said Karen LeBlanc, director of performance audit for the Legislative Auditor’s Office.
“As far as if it’s going to be better or not, I have no idea,” LeBlanc said.
The auditor has cited problems with DHH oversight of the private health insurance companies including relying on the companies data instead of doing independent checking of their activities.
LeBlanc said the last couple of years DHH has hardly done any monitoring of the emergency medical transportation program.
From 2011 through 2014, the program paid more than 1.2 million in claims at a cost of $83.3 million.
According to the audit, the health agency:
Paid out 55,474 claims for $1.68 million that did not have a corresponding medical claim on the same day as the transportation occurred. It also made $103,258 in payments that potentially violated rules governing the nonemergency transportation program — $90,000 of the payments going for trips to the pharmacy.
Has not conducted on-site monitoring of nonambulance providers since January 2014 and even when it did, the agency did not seek reimbursement when it identified payments that were in noncompliance with program rules. For instance, DHH’s 2013 review found 34 percent of 3,514 forms that serve as evidence that rides occurred were either missing or not properly filled out.
Has never monitored ambulance providers to determine if support existed for the rides they provided to Medicaid recipients although ambulance transportation accounted for $45.8 million of the $83.3 million program between 2011 and 2014.