- The Washington Times - Monday, January 10, 2005

A D.C. program that picks up the tab on hundreds of thousands of dollars in cab rides each year for low-income ailing residents has failed to guard against fraud, waste and abuse, the first of a series of audits into the District’s Medicaid system concludes.

The District’s taxicab voucher program spent about $1.5 million in cab fare for disabled and ill residents in 2002 and 2003, but city records failed to show who received the rides or what happened to vouchers sent to dozens of hospitals, nursing homes and clinics, an audit by the D.C. Office of the Inspector General has found.

In the audit, which was completed last month, the office also questioned what happened to $44,000 in voucher payments in 2002 and 2003 because records that show how the money was spent were missing. The office’s Medicaid fraud division is probing those payments, the audit states.

Stanley Tapscott, a private cab operator who serves on the D.C. Taxicab Commission, said yesterday that the voucher system long has had problems. He said many cabdrivers in the District are reluctant to participate in the program because of trouble getting paid.

“Some drivers shun it,” he said. “The cab business is a cash-money business. If you get one of these vouchers, then you have to go [to the D.C. Department of Health] and find parking, then you go in, then you wait to get paid — that’s been a problem over the years.”

Mr. Tapscott, however, said that in the past the program also has had a reputation as an easy way for unscrupulous drivers to make extra money.

“There were some drivers years ago who went to jail,” Mr. Tapscott said. “They’d go down and just get a handful of forms to fill out, then they’d go back and get paid. I hope that’s all been cleared up.”

The taxicab commission has no hand in the voucher program, which is run by the D.C. Department of Health and the D.C. Office of the Chief Financial Officer (OCFO).

The audit is the first in a series that interim D.C. Inspector General Austin A. Andersen is working on as part of a sweeping review of the city’s Medicaid program, which pays for health care services provided to low-income people. The D.C. Department of Health administers the federally funded program in the city.

City health and finance officials have said they agree with most of the findings of the audit and have submitted plans to correct the problems.

Dr. Gregg A. Pane, director of the D.C. Department of Health, said yesterday that most of the problems had been corrected by the time he took over the department in the fall.

“We’re on top of it now,” he said.

In a letter to Mr. Andersen, Dr. Pane said officials have implemented a new system that calls for random eligibility spot checks of recipients by health officials, closer review of all vouchers and secure storage areas for files and records.

Dr. Pane said the department’s Medicaid Assistance Administration now conducts monthly reviews “to ensure that all vouchers are accounted for.”

In a letter to Mr. Andersen, D.C. Chief Financial Officer Natwar M. Gandhi outlined a plan that includes increased training and supervision of employees. He said employees now properly void vouchers and keep the documents in a locked file cabinet.

Mr. Gandhi said that as of Oct. 1, the paid taxicab vouchers are being stored in a secured cabinet in a file room.

“The OCFO will ensure adequate supervision over [employees] and related functions, through training and closer supervisory review,” Mr. Gandhi wrote.

According to the program rules, Medicaid recipients must get written permission from their doctors and be debilitated, aged, in a leg or body cast or using a wheelchair, cane or walker to be eligible to participate in the voucher program.

Instead of cash, the patient can use the voucher to pay for a ride. The driver then has six months to take the voucher to the Department of Health to receive payment. City officials then are supposed to void the voucher.

The audit noted several breakdowns in the system, including hundreds of vouchers that had not been voided and others that were not kept in a secure area.

“We could not determine the number of recipients who participated in the program or ascertain if all of the taxicab vouchers … were for qualified recipients,” the audit reads.

In response, Mr. Gandhi wrote in his letter that as of Oct. 1, “once the vouchers are processed … and a check is generated, all vouchers covered by the check along with the summary … document is perforated with the date paid before filing.”

The audit also noted that city officials had not kept track of how many such vouchers were distributed to 41 medical facilities in the District. A logbook that keeps track of voucher payments also was incomplete and contained several alterations, such as scratch-outs and white-outs, the audit found.

Mr. Gandhi wrote that “manual maintenance of [a] reimbursement log is not necessary because the approved voucher is on file and all information is accessible through [the D.C.] System of Accounting and Reporting.”

The computer-based accounting and reporting system keeps track of government spending.

Sandra Seegars, another taxicab commissioner, agreed with Mr. Tapscott and said yesterday that the voucher system was “an easy way to rip off the government.” She said changes are needed to improve oversight of the program and to boost participation among drivers.

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