Policy & Regulation News

Texas Fraudulently Claims $30.3M in Medicaid Transportation Services

By Ryan Mcaskill

In fiscal year 2011, Texas HHS wrongly claimed $30.3 in Medicaid nonemergency medical transportation in multiple offenses.

- According to a new report released by the Department of Health and Human Services (HHS) Office of Inspector General (OIG), the Texas HHS wrongfully claimed at least $30.3 million during the fiscal year of 2011 in Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services.

Federal regulations require each State to ensure that Medicaid beneficiaries have the necessary transportation to and from medical providers. These regulations define transportation expenses as costs for transportation that the State deems necessary to secure medical examinations and treatment for beneficiaries.

During the fiscal year of 2011, the Texas HHS claimed $135.6 million in payments to NEMT providers. In past audits, it was discovered that these servicers were not always in accordance with Federal and State requirements, so an additional audit was conducted. The OIG examined a stratified random sample of 90 claims, limiting the review to claims for demand-response services, which are transportation services that use contractor-dispatched vehicles.

The audit found that of the 90 sample claims examined, 70 contained services that did not comply with certain Federal and State Regulations and 23 contained multiple deficiencies.

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  • • For 51 claims, that providers could not verify the vehicle used has current State regulations and inspections or could not identify the vehicle used for the transportation services.

    • For 19 claims, children were transported without a parent or legal guardian present.

    • For 18 claims, transportation providers could not verify completed Internet computerized criminal history file background checks, drug testing and driver history checks on the drivers.

    • For three claims, beneficiaries did not receive a Medicaid-covered health care service on the transportation date.

    Based on the sample, it is estimated that the State agency claimed at least $30,385,925 in Federal Medicaid reimbursement for 980,561 NEMT claims during the 2011 fiscal year. The OIG recommends the State refund the full amount that was overpaid and strengthen its policies and procedures to ensure that all vehicles have proper paperwork, children under 15 have a legal guardian, driver background checks are complete, beneficiaries are receiving medicaid-covered services and claims are not submitted for canceled trips.

    The state did respond to the findings, saying it is currently working with the transportation providers to obtain additional support, which will be submitted to the Centers of Medicare and Medicaid Services during the audit resolution process. However, the state did not agree with the 19 ineligible claims because of unaccompanied minors but did not produce any documentation to support its statement.

    “The State agency said that we should reconsider this determination because the Texas law in effect during the audit period allowed an authorized adult to accompany the child and because the State agency had a process in place to verify the identity of the parent or legal guardian who authorized another adult to accompany the child,” the report reads.

    The OIG maintains its stance that these claims were inaccurate.