- The Washington Times - Tuesday, October 24, 2006

Federal auditors are examining the skyrocketing costs of providing transportation to Medicaid patients across the country, a problem that D.C. officials are struggling to control.

The Office of Inspector General for the U.S. Department of Health and Human Services said it “will determine whether state Medicaid agencies make erroneous payments for transportation services,” according to its recently released 2007 work plan.

Medicaid transportation costs across the nation rose by 48 percent from 1999 to 2003, reaching $1.5 billion, according to the work plan.

The District has seen its Medicaid transportation costs rise to more than $20 million overall last year. More than $16 million was spent on van rides alone, according to a report last month by the D.C. Office of the Inspector General.

But the city’s Medicaid transportation program, which also pays for public transit and taxis, cost taxpayers $14.3 million in fiscal 2004, according to the D.C. inspector general’s 2006 work plan.

The program was also the subject of recent reports by the city’s inspector general and the D.C. Council Committee on Health.

The Washington Times on Monday reported that the District last year spent $22.3 million for nonemergency transportation of Medicaid patients — slightly more than what the city paid for patients to see individual doctors, according to city records.

In the federal work plan, the inspector general does not single out the District or any state in outlining a review of Medicaid transportation services.

Medicaid, which provides health insurance for the poor, is funded by the federal government and the states, which also manage their programs.

Reimbursement rates and rules for Medicaid transportation vary by state.

“Since so much money is involved here, the federal government certainly has a very keen interest in how it is spent,” Donald White, spokesman for the HHS inspector general, said yesterday of the nationwide look at Medicaid transportation costs.

Health care consultant Robin Mathias said that it’s not uncommon for Medicaid programs to lose 30 percent to 50 percent of nonemergency transportation spending to fraud and abuse.

“States may identify likely fraud months or years after payment by analyzing claims data, but the effort is often too little, too late,” she said.

A few states, such as Illinois, are moving toward contracting with a limited number of companies through competitive bidding, instead of having an unlimited number of providers, Miss Mathias said.

“Transportation fraud is very common,” she said. “One of the reasons is that there’s no professional certification. You don’t have to be a nurse or a physician or a medical practitioner. That opens it up to a much wider range of people.”

Last month, D.C. Inspector General Charles J. Willoughby issued a report that uncovered “a serious breach of basic internal controls” in which the city’s Medical Assistance Administration failed to document millions of dollars in Medicaid transportation expenditures.

In response, Dr. Gregg A. Pane, director of the D.C. Department of Health, which oversees the MAA, wrote that the current transportation system has “profound management and operational challenges to overcome.”

Dr. Pane said that city health officials are “deeply committed to working to resolve these issues as soon as possible.”

The Times found that gaining entry into the Medicaid transportation industry in the District has required little more than a driver’s license, an inspected van, auto insurance and valid rates on file. The city has more than 200 Medicaid transportation providers.

Neither the city’s Department of Health, which oversees Medicaid, nor the Washington Metropolitan Area Transit Commission, which licenses motor carriers, has conducted background checks of company officials in recent years.

The review by The Times of court records and other official documents of transportation companies on the D.C. Medicaid provider directory found company officials with criminal histories and others with numerous driving violations.

The Washington-based Community Transportation Association of America says the District trailed only Alaska in how much it has paid for transporting Medicaid patients, according to D.C. Council documents.

Alaska encompasses more than 581,000 square miles; the District, 63 square miles. Commercial airfares account for more than 90 percent of Alaska’s Medicaid transportation costs, while the District relies mostly on a fleet of private van carriers, according to records.

The District pays companies up to $140 per trip. By comparison, a cab ride across the city could cost as much as $40, plus tip.

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