Medicaid finds nearly $200,000 in overpayments


Staff Report



Unqualified drivers provided dozens of transportation services for a Medicaid company based in Scioto County, contributing to nearly $200,000 in overpayments from the state, auditors found.

A report released today by Auditor of State Dave Yost cites 293 errors in a sample of 747 wheelchair van services provided by Portsmouth Emergency Ambulance Service Inc., also known as PEASI, from Jan. 1, 2012 through Dec. 31, 2014. Auditors identified an additional 42 errors in a sample of 919 non-emergency ambulance services.

Of 19 drivers tested, six were ineligible during the entire examination period, and another nine went periods of time when they were ineligible. In total, 53 wheelchair van services were provided by drivers who were ineligible or could not be identified.

Auditors found instances where employees did not meet Medicaid hiring requirements, including 14 drivers who failed to complete alcohol tests, and several who did not complete drug tests, criminal background checks or physician statements within 60 days or hire.

“Cutting corners with Medicaid requirements creates a no-win situation,” Auditor Yost said. “Taxpayer dollars go to waste, patients risk inadequate care and the provider in question ultimately has to pay the price.”

Other drivers never completed background checks, and one went two months without a valid driver’s license. Also, one driver never completed first aid training, and a handful of drivers had lapses in first aid and CPR training lasting up to 20 months.

In addition, trip documentation showed the miles reimbursed for 26 transportation services exceeded the miles documented.

During a review of certificates of medical necessity (CMN), which are required for service authorization, auditors discovered 24 errors resulting in overpayments. Some services had no CMNs to cover the transports, while CMNs for other services were incomplete or lacked a signature from an authorized practitioner.

Upon receiving notification that some records were missing, the provider provided additional documents for review. These included nine previously submitted CMNs altered from the original versions to include the missing information. Auditors did not accept these changes.

With $11,808 in interest, the provider owes the Ohio Department of Medicaid $211,695. The company received $3.1 million in reimbursements for 107,038 transportation services during the examination period.

Staff Report