GREENVILLE — A local medical transport business is on the hook to repay more than $478,000 according to a report issued by the State of Ohio Auditor’s Office, although the company said it will appeal the decision.
State Auditor Dave Yost recently announced that Integrity Ambulance Service LLC, of Greenville, Ohio, must repay the state $478,094, as a result of what it says was more than $448,000 in improper Medicaid payments.
The demand for payment is a result of transportation services being provided without proper authorization, according to an examination conducted by the Auditor.
The Auditor’s Office said findings from the examination of the non-emergency medical transportation service showed that during the period of July 1, 2011 through June 30, 2014, Integrity was overpaid by $448,428. With interest in the amount of $29,666, the provider owes the Ohio Department of Medicaid $478,094.
Auditors tested 862 transports in three statistical samples and identified 227 services in which there was no certificate of medical necessity to cover the date of service, which is required for service authorization.
Additionally, the audit found 241 transports in which the applicable certificate did not certify the recipients met any criteria for medical necessity, did not include a medical condition and/or were not signed by an authorized practitioner.
In addition, a review of trip documentation found overpayments as a result of the following 32 errors:
- 10 transports with no trip documentation;
- 7 transports in which the miles billed exceed the miles documented;
- 6 transports for which it could not be determined if one point was to a Medicaid covered service;
- 4 transports by an ineligible driver;
- 3 transports in a vehicle prior to it being licensed; and
- 2 cancelled trips without required documentation for a cancelled trip.
“Rules governing the use of Medicaid wheelchair van services are designed to ensure patient safety and proper reimbursements,” Yost said. “Complying with driver qualifications, service documentation and service authorization, among other requirements, are non-negotiable.”
Integrity President/CEO/Founder Brad Feldner, saying Integrity had cooperated with the State Auditor’s Office in its audit, told The Daily Advocate the problem lies with the state’s own paperwork, not with Integrity.
“Out of 500 ‘errors’ found by the auditors, 468 of them dealt with technical insufficiencies in Physician Certification Statements that are required to be completed by third parties (physicians, nursing homes, or hospitals) who are requesting the transport of their patients,” he explained. “The content of these forms is outside of the control of wheelchair van providers. (These forms were drafted by the State, and were by the State’s own admission ‘confusing’ during the time frame at issue.) The State has since revised these forms to better comply with their own regulations, however those revisions were not taken into account in the determination of the claims at issue in this matter.”
In light of this, Feldner says Integrity will appeal the ruling.
“Integrity does not agree with the findings of this audit and intends to appeal the overpayment assessment,” he said. “Integrity provided all of the services it billed the Medicaid program for on behalf of the patients transported.”
“Integrity strives to be compliant with the myriad rules and regulations that apply to the provision of transport services and believes that most of the denied claims will be overturned and paid during the appeal process,” Feldner added.