Medicare’s Inspector General released a startling report claiming that New Jersey did a horrible job of overseeing its Medicaid nonemergency medical transportation program. As a result, the feds believe that 2,538,674 claims worth $65 million dollars did not comply with program requirements. Multiply that by 49 states, Puerto Rico and the Virgin Islands and it is easy to see that taxpayers are probably getting hosed.
The Office Inspector General serves as the “top cop” for the federal Medicare and Medicaid programs. Because Medicaid is funded with both state and federal tax dollars, either the state or federal government can investigate claims of Medicaid fraud. Here the Inspector General audited New Jersey’s nonemergency medical transportation program to see if it was in compliance. It wasn’t. That doesn’t mean that New Jersey engaged in Medicare fraud but it certainly allowed others to do so.
Medicaid’s Medical Transportation Program
Medicaid is primarily a low income health insurance program funded with state and federal tax dollars. The program pays for rides to and from medical appointments. Medical transportation has long been rife with fraud. (Just last we week wrote about a $1.1 million dollar medical transportation Medicaid fraud scheme in Dallas involving Yellow Cab.)
Under New Jersey’s nonemergency medical transportation program, the state elected to contract with a vendor to administer the program. That vendor is required to maintain a provider network, verify beneficiary eligibility, authorize the appropriate mode of transport on the basis of medical necessity, and dispatches vehicles to transport the beneficiary.
In just one year, New Jersey paid its vendor, LogistiCare, $113,259,311 for nonemergency transportation. The federal share of that amount was $59,629,656.
The feds performed a random audit to see if New Jersey was properly monitoring its vendor. It found that the state fell short of its obligations. Specifically, the Inspector General noted that the state failed to insure that:
- vehicles used to transport Medicaid beneficiaries met State requirements,
- transport personnel were licensed and qualified,
- prior authorizations were obtained and medical necessity documentation was maintained for beneficiaries who required certain transportation services,
- transportation providers maintained required insurance coverages,
- beneficiaries received Medicaid-eligible medical services on the date of transportation, and
- transportation services were adequately documented.
As a result of the audit, the feds found that just 12% of the claims sampled met requirements.
It is important to remember that it is the vendor who is ultimately responsible for compliance. After the audit, New Jersey generally agreed with the findings and said that it would amend its contract with its vendors to insure the vendors must pay if they don’t meet future service levels.
It isn’t just nonemergency medical transportation that has problems. Ambulance transports are also subject to widespread abuse. In certain areas of the country such as Philadelphia and Houston, things have become so bad that regulators have had to place a moratorium on new EMS services. [In the interest of full disclosure, we are presently prosecuting an ambulance company, LifeStar Response, for violating Medicare regulations for both emergency and nonemergency medical transports.]
Medicaid Fraud and Whistleblower Awards
Whistleblowers with inside (“original source”) information about Medicaid fraud are entitled to an award of up to 30% of whatever money is recovered by the federal government. About 2/3rd’s of the states have their own Medicaid fraud laws that also pay awards. (New Jersey is one such state.) In these states you can receive two awards!
To collect an award, you have to first file a sealed complaint in court. Awards are generally only paid to the first to file. Wait to long and you may get nothing. The better lawyers that handle these cases mostly do so on a contingent fee basis meaning you pay no fees unless you recover money.
If you have information about Medicaid fraud, give us a call. Our whistleblower clients have already received over $100 million in whistleblower awards. For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). All inquiries kept strictly confidential. You can also view our healthcare fraud information page.
MahanyLaw – America’s Medicaid Fraud Lawyers