- The Washington Times - Monday, October 23, 2006

Kayode Y. Abrams had nearly a dozen traffic citations and a criminal record when the District’s Medicaid agency hired his company to drive the city’s neediest to medical appointments.

And when Abrams’ company wasn’t transporting Medicaid patients, the 33-year-old businessman had a side job: He was an organizer in a Northern Virginia crack-cocaine ring, according to court records.

Despite his criminal record, Abrams won certification as a Medicaid provider in the District.

It was no fluke.

Gaining entry into the lucrative but little-known industry has required little more than a driver’s license, an inspected van, auto insurance and valid rates on file.

Neither the D.C. 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.

City officials recently have pledged to reform the troubled program, but the lack of oversight raises questions about the overall management of the city’s more than $1 billion Medicaid program.

Last year, the District 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.

“There’s more paid for transportation trips than doctor visits, and anybody can tell you that smells,” says D.C. Council member David A. Catania, at-large independent.

Kayo LLC, founded in 2002, was one of about 200 Medicaid transporters operating in the city before it collapsed in the wake of Abrams’ arrest and 10-year prison sentence last year.

Even with its owner in prison, Kayo LLC remains on a directory of Medicaid providers posted by the Department of Health on its Web site.

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

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

Dead riders

The District’s management of nonemergency transportation for Medicaid patients has come under increasing scrutiny in the past year.

Both the D.C. Office of the Inspector General and the D.C. Council Committee on Health have investigated the program. Federal authorities this year indicted the owner of one company, the Voice of Social Concern, while a criminal investigation into another continues.

Last month, the Office of the Inspector General for the federal Health and Human Services Department filed a search warrant affidavit on three vans operated by Mash Transportation Inc. of Hyattsville.

The Washington Times has obtained a copy of the search-warrant affidavit.

According to the document, Mash Transportation has filed dozens of Medicaid claims for transporting patients who were dead.

In one case, a Medicaid recipient died Jan. 6, 2000, but Mash continued to bill the District’s Medicaid program dozens of times for rides for months after the date of death, according to the affidavit.

The FBI and the inspector general also have been investigating whether Mash fraudulently reported that recipients were confined to wheelchairs, which would have allowed the company to be paid at a higher reimbursement rate, according to the affidavit.

Authorities also noted that Mash received $410,784 for transporting D.C. patients in 2003, when the average total receipts for such services was about $60,000.

Since 2001, the company has received more than $1.8 million from the District, federal documents show.

Federal authorities declined to comment on the investigation.

The company also declined to comment.

Mash’s owner, identified in the federal affidavit as Hind Seidahmed Abdelmati, was out of the country visiting Sudan when contacted last month, said Mash billing manager Mohamed Nazar.

“I’m not familiar with what’s going on,” Mr. Nazar said. “All I know is the FBI came and took some stuff. We’re still operating.”

He said that Miss Abdelmati goes “back and forth” between the United States and Sudan and that “she should be back at some point.” He said that he has not spoken with her about the FBI search of company vans.

Criminal histories

Almighty Time Investments Inc., based at the Accokeek home of Hakeem and Tola Shonekan, last year received $149,000 from the D.C. government for Medicaid transportation.

The company was formed in 1999, at about the time of Mr. Shonekan’s release from federal prison. He pleaded guilty to attempted possession of 2.8 kilograms of heroin and intent to distribute.

He came under investigation after federal authorities discovered that he was traveling from Nigeria into the United States with two suitcases that had secret compartments containing heroin, according to court records.

It could not be determined whether Mr. Shonekan, until recently the company’s registered agent, is a driver for Almighty Time or whether his conviction surfaced in filings with the transit commission or the D.C. Medical Assistance Administration.

He referred all questions to the company’s owner — his wife, Tola.

Mrs. Shonekan said that her husband’s past doesn’t have anything to do with her company.

“What does that have to do with this business?” she said. “I’m a good citizen with good standing in this country.”

The couple was contacted by The Washington Times this summer. In July, Almighty Time dropped Mr. Shonekan as registered agent.

Another Medicaid transporter — Sarah Gwangwa’a, vice president of Ultimate Transportation — has had misdemeanor larceny charges and several traffic citations filed against her in Virginia during the past seven years, court records show.

Miss Gwangwa’a said that her legal troubles “happened in the past” and did not involve Ultimate Transportation.

She also said that the company has its own driver and that her traffic violations didn’t occur on company time.

She was sentenced to 180 days in jail in connection with a 2001 larceny charge. All but four days of the sentence were suspended.

The Times informed D.C. officials about the findings of its review of transportation providers.

In response to questions from The Times, D.C. Medicaid officials said that they plan to start conducting background checks of company owners, in addition to ongoing spot checks of drivers.

Out-of-towners

Earlier this year, D.C. cabdrivers were outraged about the city government’s plans to enforce a rule aimed at keeping money spent on cab fares in the District.

The rule bars new cabdrivers from registering their vehicles in the District if they do not live in the city.

When it comes to Medicaid transportation, the District sends more than half of the $22.3 million it spent last year to operators based in Virginia and Maryland.

By comparison, of the more than $1.1 billion the District paid last year to Medicaid providers — including hospitals, doctors and nursing homes — only 8 percent went outside of the District, according to city records.

Some of the transportation companies can be difficult to trace. The District’s list of certified Medicaid operators on its Web site provides information that appears outdated.

Some companies have disconnected phone numbers, wrong numbers and, in one case, an answering machine that played several minutes of music before disconnecting.

In some cases, companies have different names and locations but appear closely tied.

Amezene Zewdie runs Efficient Transportation, based in Alexandria, according to public records. It received $129,000 for D.C. Medicaid services last year.

In 2004, Mr. Zewdie filed for personal bankruptcy, listing his only income as $1,229-per-month in unemployment. His largest asset was a home in Springfield, which he co-owned with his brother, Mesfin Zewdie.

The co-owned Springfield property also serves as the corporate headquarters of another D.C. Medicaid carrier, Sheltox Transportation, which is run by Mesfin Zewdie and received $109,000 from the District’s Medicaid program last year, records show.

‘Completely broken’

“Up until now, the system can be characterized as a total joke,” says Mr. Catania, chairman of the council’s Committee on Health. “It’s been the wild, wild West.”

In a budget report, Mr. Catania said that the city’s transportation system “is functioning poorly at best, completely broken at worst.”

According to a study cited by Mr. Catania in recent budget documents, the Washington-based Community Transportation Association of America says the District trailed only Alaska in how much it has paid for transporting Medicaid patients.

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 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.

The D.C. inspector general’s audit, released Sept. 29, found that the city’s Medicaid program did not have records to document the vast majority of nonemergency Medicaid transportation claims last year, calling the failure “a serious breach of basic internal controls.”

It also found that the Medical Assistance Administration did not conduct any on-site visits of transportation companies to ensure that services were being provided.

In response, the city Health Department said it is overhauling the transportation program to require physicians’ signatures for authorization.

Dr. Gregg A. Pane, the District’s health director, recently wrote that the current transportation system has “profound management and operational challenges to overcome.”

In a letter to the inspector general, Dr. Pane said city health officials are “deeply committed to working to resolve these issues as soon as possible.”

Mr. Catania says that he has given city Medicaid officials a mandate to improve their oversight. He also has cut their transportation budget by $2 million and redirected the money to cover dental benefits for Medicaid recipients.

“When I saw the budget line item for transportation versus how much we spent on physicians, I thought, ‘Wait a minute,’” he says. “We’ve seen that anyone with a van or a car can get in it as long as they get registered with the Washington [Metropolitan] Area Transit Commission.”

Making changes

Regulators have not conducted background checks of those whose companies — often one- or two-person businesses — earn tens of thousands of dollars per month driving Medicaid patients to appointments.

Among the most basic problems, Mr. Catania said, has been a lack of records to ensure that rides are medically necessary.

“The barriers necessary to control costs were simply ignored. They simply weren’t there. We cannot prove whether any of the people who got rides were Medicaid recipients,” Mr. Catania says.

According to a report by a D.C. Council Committee on Health earlier this year, the District has the nation’s second-largest rail system and fifth-largest bus system, but only 1 percent of the city’s nonemergency transportation spending is paid for public transit.

To get on the road as a Medicaid contractor in the District, companies must apply for certification from the Washington Metropolitan Area Transit Commission. The agency checks to make sure carriers have proof of insurance, an inspected vehicle and ride rates on file.

The transit commission’s rules have provided no more scrutiny of Medicaid operators than they do of limo drivers, which the commission also regulates.

The District’s Medicaid agency has contracted with Affiliated Computer Services Inc. to check drivers’ backgrounds, but the backgrounds of company officials aren’t subject to checks.

Robert Maruca, deputy director of the D.C. Medical Assistance Administration, said that the District is overhauling its Medicaid transportation program in the wake of a series of critical reports from Mr. Catania and the inspector general.

In addition, fraud charges against one of the city’s biggest companies, the Voice of Social Concern Association, has focused attention on the program.

“We’re stepping up the scrutiny of claims to look for fraud and waste,” Mr. Maruca said.

He said that the Medicaid agency is asking the 200 transportation companies that the District does business with for a list of all drivers so officials can conduct background checks. He said that the city also would conduct checks of company officials.

Mr. Maruca said his agency notifies federal authorities about suspicious billing patterns. The investigation into Mash Transportation began after such a tip, federal authorities said.

Yet several companies have gone years without valid business-incorporation papers on file. Of those that do, many have corporate registrations that have expired or have been revoked.

Companies without valid business charters are barred from conducting business in the District.

“That’s a big concern for us,” said William S. Morrow Jr., executive director of the Washington Metropolitan Area Transit Commission. “We don’t want an insurance company to say, ‘Well, we wrote insurance for company “X,” but company “X” doesn’t exist anymore.’”

Mr. Morrow said that the transit commission, which regulates for-hire bus and van and some sedan and limo operators, recently has cracked down on companies without valid business charters.

Transit commission records show that officials have begun dozens of investigations in recent months into companies that have failed to maintain their business charters or insurance papers.

Several companies, including D.C. Medicaid transporters, have had their licenses suspended.

“There is a statute that requires carriers provide safe and adequate service. If what somebody is doing is unsafe, we can and do put a stop to it. As carriers come to our attention for failing to keep up a tariff or insurance, we’ll investigate that, too,” Mr. Morrow said.

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