With interest in the amount of $29,666, the provider owes the Ohio Department of Medicaid $478,094.
Auditors tested 862 transports in three statistical samples and identified 227 services in which there was no certificate of medical necessity to cover the date of service, which is required for service authorization.
The audit also found 241 transports in which the applicable certificate did not certify the recipients met any criteria for medical necessity, did not include a medical condition and/or were not signed by an authorized practitioner.
In addition, a review of trip documentation found over-payments as a result of the following 32 errors:
- 10 transports with no trip documentation
- 7 transports in which the miles billed exceed the miles documented
- 6 transports for which it could not be determined if one point was to a Medicaid covered service
- 4 transports by an ineligible driver
- 3 transports in a vehicle prior to it being licensed, and
- 2 cancelled trips without required documentation for a cancelled trip.
“Rules governing the use of Medicaid wheelchair van services are designed to ensure patient safety and proper reimbursements,” Yost said in a prepared statement released Nov. 22. “Complying with driver qualifications, service documentation and service authorization, among other requirements, are non-negotiable.”