Feds want Medicaid payments returned for common ambulance services

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Mother, daughter dead after apparent murder-suicide at San Francisco nursing home
Mother, daughter dead after apparent murder-suicide at San Francisco nursing home

Medicaid programs across the country are taking pause to ensure their non-emergency medical transportation services (NEMT) are operating properly after one state agency was told to return nearly $400,000 for improper bills paid by the federal government.

Providers and program administrators were put on alert as the Office of Inspector General for the Department of Health and Human Services laid out its case in a January 29 report. The watchdog has “consistently identified this area as vulnerable to fraud, waste, and abuse” since it began conducting audits in numerous states in 2006.

The OIG uncovered nearly $375,000 in improperly billed claims following a review of Medicaid fee-for-service claims paid to medical transportation providers in California for NEMT services from July 1, 2010, through June 30, 2011.

State and federal Medicaid rules generally cover only the lowest cost NEMT services available for beneficiaries, but in numerous instances, that wasn't the case in the California audit. In several instances, for example, transportation providers improperly billed the NEMT services as ambulance transfers from acute care hospitals to skilled nursing facilities, investigators said.

Although the documentation for each provider showed that a transfer was provided, the documentation did not support the need for an ambulance. Other deficiencies resulted from insufficient documentation, service date discrepancies and improperly billed services for higher-rate “night call” services.

HHS has asked California to repay most of the flagged payments and educate service providers about the rules.