Columbus – More than two-thirds of all Medicaid charges by a Cleveland-based ambulette service were not doctor-approved, according to an audit released today by Auditor of State Dave Yost. Medicaid rules require certificates of medical necessity prior to payments for covered services, such as transportation.
"I want every Medicaid provider to understand this: No need, no pay,” Yost said. "Taxpayer funds are not an open spigot, and every dollar wasted means families are going without. Confirm the doctor’s approval or do not do the service, it is that simple."
During a two year period, 2008 and 2009, American Care Medical Transportation, Inc. billed a total of $752,424.21 in Medicaid-paid charges to the Ohio Department of Job and Family Services. Of that amount, the audit released today found $532,270.55 to be improper. With interest in the amount of $44,214.91, the total amount owed to Ohio Medicaid is $576,485.46. Additional interest will accrue at $116.66 daily, beginning with the release of the audit.
Services were found to be improperly charged because the Medicaid patients’ attending physicians did not certify the need for wheelchair transportation or because the ambulette company billed for medical attendant services without employing any attendants.
"Medicaid is the largest expense in the state budget, growing so fast that it is threatening all other budget priorities," Yost said. "If we cannot get our hands around proper documentation of medical necessity, both the federal and state governments are going to go insolvent, and we still will not have provided services to those most in need."
The audit also noted other deficiencies, including failure to provide CPR training, failure to complete drug and background checks on employees, and failure to properly document services.
A full copy of this audit can be found online.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,600 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.