When a Medicaid recipient in Louisiana needs to get to a doctor’s appointment, but has no means of transportation, the Department of Health and Hospitals offers a ride, either in an ambulance or a non-emergency vehicle.
At a recent Legislative Audit Advisory meeting, Chris Magee, Senior state Auditor, said the Non-Emergency Medical Transport program isn’t being properly monitored. "We've identified over fifty-five thousand claims costing over $1.6 million that did not have a corresponding medical claim on the same day of the transport," he says.
That could be for a number of reasons, like a doctor not billing Medicaid for the care, or because transportation never actually occurred. It’s the eighth consecutive year these improper payments have been found.
“We went and looked at some of the files that are suppose to be held by the transportation companies. However, we found the words ‘cancel, didn't go, dry run,’ written on some of the forms,” he explains.
Yet the ride provider still billed DHH. And DHH paid them.
"DHH stated that due to the rural locations of some providers, and them being the only transportation option in some of these small towns," says Magee, "that sanctioning or suspending them would run them out of business." And if that happened, patients may be left with no transportation option at all.
DHH Secretary Kathy Kliebert acknowledged the findings. "We’ve had these findings for a number of years. We've made numerous attempts to address them, none of which have been successful," she says.
40,000 to 50,000 people use the service each year in Louisiana. As of December 1st, the program was placed under the authority of Bayou Health, which Kliebert says is better able to monitor the claims. "We’ll make sure that we’re paying for the services these people need without dismantling the program to the point where people aren’t getting these services," says Kliebert.