Ohio Auditor of State Dave Yost - Press Releases - Medicaid

Toledo Medicaid Psychiatrist Charged $24,000

Tue, 12 Feb 2013 12:00:00 -0400

Columbus — Failure to document services cost Toledo-based psychiatrist Bhupinder S. Chahal, M.D. (Lucas County) $24,000 in Ohio Medicaid charge-backs, according to an audit released today by Auditor of State Dave Yost.

“A private business may follow any recordkeeping practices it chooses,” Auditor Yost said. “But when public funds are involved, then documentation must meet state and federal standards. Document the service, according to the rules, or expect not to be paid for it.”

The charge-backs amounted to about 13 percent of the doctor’s relevant billings, $155,832. Examination of records showed 30 errors in 65 services, and no supporting documentation for 29 out of 116 visits. Auditors calculated overpayment in the amount of $20,444.38. With interest, $23,764.77 is owed to Ohio Medicaid.

Medicaid providers must bill the appropriate type of visit by the attending physician treating a psychiatric patient, including exchanges with nursing or other medical personnel. Although services were billed, records were inadequate under applicable regulations to document that services were provided.

The Auditor of State’s office performs audits of Medicaid providers to ensure compliance with reimbursement rules and to confirm that services billed to Ohio Medicaid are properly documented and consistent with professional standards of care, medical necessity, and sound fiscal, business, or medical practices.

A full copy of this audit can be found online.

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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.

Contact:
Carrie Bartunek
Press Secretary
614-644-1111

Lack of Medical Need Results in 100 percent Rejection of Payments to Medicaid Provider

Thu, 04 Oct 2012 12:00:00 -0400

Columbus – An accelerated two-month audit of Tuba Rescue Transportation, a Hamilton County-based Medicaid provider, resulted in the denial of more than $306,000 in services billed for transportation of Ohio Medicaid patients, according to an report released today by Auditor of State Dave Yost.

Medicaid rules require certificates of medical necessity prior to payments for covered services, such as transportation.

“Taxpayers in Ohio and nationwide are willing to support Medicaid when it is medically necessary,” Auditor Yost said. “The best control we have, sometimes the only control to tell us the need is there, is the doctor’s order.”

Even though the provider confirmed it was aware of Medicaid rules requiring certificates of medical need, no certificates were provided for any of the services rendered during the audit period.

Other citations in the audit included:

Only two of four drivers employed by the provider were properly certified as required under state law.
Of 100 dates of services examined by the auditors, 200 instances of failed documentation were found—two for every patient served. Missing information included dates, pick up and drop off locations and times, mileage, driver’s and patient’s names and, in 24 of the 100 instances examined, no documentation at all.

A full copy of this audit can be found online.

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Contact:
Carrie Bartunek
Press Secretary
614-644-1111

Medicaid Dollars Go Undocumented

Thu, 20 Sep 2012 12:00:00 -0400

Columbus – Insufficient records and care given that was never ordered by a doctor led to more than $195,000 in findings issued in the Medicaid provider audit of Carol S. Sito, LPN (Ashtabula County), released today by Auditor of State Dave Yost.

“She was warned that her documentation was bad, and she ignored it,” Auditor Yost said. “Improper payment for home care is one of the most common areas of waste and fraud in one of the largest government programs there is, and good records are about the best tool we have to fight against that.”

The 2010 financial report for U.S. Health and Human Services estimated that 9.4 percent of all payments to Medicaid providers was improper, with the nationwide federal share alone estimated at $22.5 billion. Ohio spends more than $18 billion annually on Medicaid, including both state and federal share.

The audit reviewed claims for services Carol S. Sito, LPN rendered to Medicaid patients and payments received during the period of July 1, 2007 to April 30, 2011. During that time, Sito was reimbursed $377,657.73. Due to insufficient or missing documentation, a total of $195,153.21 in findings was issued, along with $19,675.72 in interest. Additional interest will accrue at the rate of $42.77 per day after August 20, 2012 until the findings are repaid.

During the audit period, Sito failed to prepare clinical records and timesheets for services according to Medicaid rules. Instead, she made photocopies of prior clinical notes, and many timesheets did not contain original signatures. Prior to the audit period in 2007, Sito was warned by ODJFS that this practice was unacceptable. As a result, the Auditor of State’s office disallowed $121,238.39 in reimbursements.

Auditors also identified one plan of care that was not signed by a physician, and therefore is invalid. Reimbursements for the 61 services covered in this plan of care were disallowed, and a finding in the amount of $18,623.01 was issued. There also were 18 services billed after a plan of care expired. The reimbursements were disallowed, and a finding of $5,268.21 was issued.

According to Ohio Medicaid rules, services not specifically stated in a plan of care or an all-services plan are not reimbursable. Auditors reviewed Sito’s records and identified 1,488 hours of service (5,952 units) that were overbilled to Ohio Medicaid, and a finding of $50,023.60 was issued.

A full copy of this audit may be accessed online.

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Contact:
Carrie Bartunek
Press Secretary
614-644-1111

Ambulette Company Found to Owe Medicaid more than $570,000 for Undocumented Service

Thu, 26 Jan 2012 12:00:00 -0400

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.

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Contact:
Carrie Bartunek
Press Secretary
614-644-1111

State Auditor Issues $74,500 in Findings of Undocumented Medicaid Payments

Tue, 17 Jan 2012 12:00:00 -0400

Columbus – Continuing documentation failures for Medicaid-provided oxygen service are putting both patient health and taxpayer dollars at risk, said Auditor of State Dave Yost today. Yost made his comments in response to an audit of Lincare, Inc., a national Medicaid provider specializing in durable medical equipment, including oxygen equipment.

“Certification of need is an essential step for both patient health and taxpayer value,” Yost said. “Proper documentation is not busywork, it is basic work, and it must be done.”

The audit released today included more than $74,500 in findings against the Franklin County location of Lincare, Inc., which operates throughout Ohio. Lincare was found to owe the Ohio Department of Job and Family Services $74,551.42 in Medicaid reimbursements, including interest.

The findings result from non-compliance with Medicaid reimbursement rules for oxygen services. Oxygen services require physician approval by means of certificates of medical necessity, similar to prescriptions. The audit found Lincare provided incomplete or missing certificates and failed to document medical evaluation of patients prior to the prescription of oxygen services.

The audit reviewed Medicaid reimbursements filed by Lincare from Nov. 1, 2007 to Oct. 29, 2009. During this time, the provider was reimbursed $236,742.45. Recoverable findings were calculated at $64,993.00, with accrued interest in the amount of $9,558.42.

The audit released today is the fourth audit of Lincare since August to include findings for reimbursements in violation of applicable requirements. Findings in the amount of $14,154.56 were issued at the Summit County business under the name America’s Best Medical Equipment in August; in the amount of $45,269.53 were issued at the Ashtabula County location in September; and $8,832.31 at the Licking County location in October.

A full copy of this audit can be found online.

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Contact:
Carrie Bartunek
Press Secretary
614-644-1111

Audit of Medicaid Provider Triggers More Than $100,000 in Findings for Recovery

Fri, 30 Sep 2011 12:00:00 -0400

Columbus - More than $86,000 in undocumented Medicaid charges, along with $15,233.96 in accrued interest, added up to $102,223.96 in findings for recovery issued in the audit of reimbursements made to Michael Linville, LPN, released today by Auditor of State Dave Yost.

“Medicaid providers are responsible not only for their patients, but also for the tax dollars that flow to them,” Auditor Yost said. “Without a paper trail, questions arise.”

The scope of this audit of Linville was limited to claims for which he provided services to Ohio Medicaid patients and received payment during the period of July 1, 2006 to June 30, 2009.

In two separate samplings of Linville’s home care nursing services, auditors identified $5,124.99 and $81,865 in findings owed to the Ohio Department of Job and Family Services for services reported, but not properly documented. For example, Linville failed to provide nursing notes and patient plans of care authorizing him to provide services.

Accrued interest of $15,223.97 was added to the findings through September 29, 2011. After September 29, 2011, additional interest will accrue at the rate of $19.07 per day until the findings and interest are paid in full to the Ohio Department of Job and Family Services.

The Auditor of State’s office performs audits of Medicaid providers to ensure compliance with reimbursement rules and to confirm that services billed to Ohio Medicaid are properly documented and consistent with professional standards of care, medical necessity, and sound fiscal, business, or medical practices.

A full copy of this audit can be found online.

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The Auditor of State’s office, one of five independently elected 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.

Contact:
Carrie Bartunek
Press Secretary
(614) 728-7198

State Auditor Issues $45,000 in Medicaid Findings for Recovery

Thu, 08 Sep 2011 12:00:00 -0400

Columbus - Incomplete or missing documentation of medical evaluations resulted in more than $45,000 in findings for recovery in a Medicaid audit released today. The Ashtabula location of Lincare, Inc., a national supplier of durable medical equipment operating throughout Ohio, was found to owe the Ohio Department of Job and Family Services $45,269.53 in Medicaid reimbursements, including interest.

The findings result from non-compliance with Medicaid reimbursement rules for oxygen services. Oxygen services require physician approval by means of certificates of medical necessity, similar to prescriptions. The audit found Lincare provided incomplete or missing certificates and failed to document medical evaluation of patients prior to the prescription of oxygen services.

“Doctors are busy, providers are busy and patients are busy, but you can’t cash a check before you write it,” Yost said. “Proper documentation is essential both to patient health and taxpayer value. These certificates are there to ensure that services are appropriate and that reasonable procedures are in place.”

The audit reviewed Medicaid reimbursements filed by Lincare from Nov. 1, 2007 to Oct. 29, 2009. During this time, the provider was reimbursed $156,418.57 for 1,345 services. Recoverable findings were calculated at $40,590.00, with accrued interest in the amount of $4,679.53.

Although no finding was issued for a separate material reportable condition, the audit also found ambiguities in plans of treatment for patients, concluding that the plans were not based on individual patient needs. The plans failed to specify whether qualifying diagnostic tests were to be performed at rest, during sleep or during exercise, as required by regulation, and also resulted in Lincare making determinations about tests and testing conditions instead of the prescribing physician.

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Taylor: Cleveland Medicaid Provider Owes State Nearly $900,000

Thu, 10 Jun 2010 12:00:00 -0400

Cuyahoga County - Auditor of State Mary Taylor today released the audit of Adult Latchkey, Inc., a Cleveland-based Medicaid provider. The audit shows that the transportation provider owes the state $868,052.94 for improperly billed Medicaid services.

“Abuse of Ohio’s Medicaid system will not be tolerated,” Taylor said. “My office will continue to work to ensure that Medicaid providers who fail to follow state law are held accountable.”

The Ohio Department of Job and Family Services (ODJFS) reimbursed Adult Latchkey $802,612.53 for more than 62-thousand transportation services the company claimed it provided to Medicaid patients between July 1, 2004 and June 30, 2009. However, Taylor’s audit reveals that none of the services were valid and says the transportation company now owes every tax dollar back to the state plus $65,440.41in interest.

The primary billing problems that require Adult Latchkey to reimburse the Medicaid program include:

Transportation of patients who were not confined to a wheelchair
Transportation of patients to a location not covered by Medicaid
Services that lacked required proof of medical necessity

Taylor’s report also shows that Adult Latchkey would oftentimes pack one vehicle with multiple passengers, then bill the state as if each Medicaid patient was transported individually. This practice is forbidden and it allowed the company to bilk the state out of more money than it should have received.

Medicaid provider audits are a component of Taylor’s comprehensive approach to improving the efficiency and effectiveness of Ohio’s Medicaid program. Medicaid is currently the most costly program in state government.

The complete report is available online.

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The Ohio Auditor of State’s office is a leader in the accounting and auditing field, earning prestigious national honors from the Government Finance Officers Association, the National White Collar Crime Center and the National State Auditors Association.

Contact:
Steve Faulkner
614/644-0056

Taylor: Audit Shows Springfield Medicaid Provider Owes Ohio More Than $309,000

Tue, 18 May 2010 12:00:00 -0400

Clark County - Auditor of State Mary Taylor today released the audit of Quality Care Transport, LTD, a Springfield-based Medicaid provider. The audit identified $309,336.33 in Medicaid reimbursements repayable to the Ohio Department of Job and Family Services (ODJFS) due to 467 errors in billing documentation.

“Medicaid providers who fail to comply with state regulations must be held accountable for the misuse of public monies,” Taylor said. “My office will continue to work to make sure taxpayer dollars are spent legally and appropriately and as the law requires.”

The audit reviewed Medicaid reimbursements filed by Quality Care Transport between July 1, 2004 and March 31, 2007. According to the report, the ambulance and ambulette service provider failed to accurately document patient transports. This resulted in $254,045 in findings and $55,291.33 in accrued interest that the transportation provider must repay to ODJFS, the designated state agency that administers Ohio’s Medicaid program.

The majority of documentation errors involved incomplete and invalid Certificates of Medical Necessity (CMN), the transportation equivalent of a doctor’s prescription that ensures transports are provided only for a medically necessary purpose. Other documentation errors included:

Billing for mileage greater than 50 miles without appropriate justification.
Billing for mileage greater than was supported in transport records.
Billing with missing or incomplete requisite trip documentation.

In addition to billing documentation errors, the audit identified four matters for attention, or noncompliance issues that could result in future monetary findings. In particular, the audit found that Quality Care Transport improperly altered CMNs, billed Medicaid for services potentially covered by Medicare, failed to indicate third party insurance and lacked patient certification on ambulette CMNs.

A review of employee personnel files also revealed that some Quality Care Transport employees lacked criminal background checks and/or periodic driving record reviews. While this did not result in a monetary finding, failure to comply with this regulation could place patients in harm’s way and jeopardize Quality Care Transport’s status with the Medicaid program.

The complete audit report is available online.

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Taylor Audit Shows More Than $150,000 in Improper Billing by Medicaid Provider

Thu, 15 Oct 2009 12:00:00 -0400

Toledo -

Auditor of State Mary Taylor today released the Medicaid provider audit of LifeStar Ambulance, Inc. The audit reveals that the Toledo-based medical transportation provider owes the Ohio Department of Job and Family Services (ODJFS) $157,719.24 for improperly billed Medicaid services and $26,168.43 in accrued interest. LifeStar repaid the entire amount at the end of September.

“Our audit staff is making an impact on the Medicaid system by holding providers accountable for the services they provide. Our audit work successfully identified inappropriate billing practices used by LifeStar Ambulance. In response to our audit findings, LifeStar reimbursed every penny owed to the Medicaid system,” Taylor said. “My office will continue to work to make sure all public funds are spent legally and appropriately and as the law requires.”

The audit reviewed Medicaid services billed to ODJFS from April 1, 2004 through March 31, 2007. The audit shows that LifeStar Ambulance, Inc. improperly billed Medicaid $159,205.97 for ambulance and ambulette transportation services during the three-year audit period. During the course of the audit the provider repaid $1,486.73, bringing the overall finding for recovery total to $157,719.24.

Furthermore, the provider failed to comply with various Medicaid rules, resulting in overpayments. Some of the more notable practices that led to the overpayments include:

Billing for transports longer than 50 miles without appropriate justification. The Medicaid program requires that providers document a reason for taking a patient out of their community.
Charging for services twice when only one service was performed.
Billing for services that did not have the necessary supporting documentation, including missing or incomplete Certificates of Medical Necessity (CMN). CMNs are the transportation equivalent of a doctor’s prescription and ensure that the transports provided are for a medically necessary purpose.
Billing transportation services with overstated mileage.
Billing both Medicaid and Medicare for the same ambulance services.
Billing Medicaid for Medicare-covered services. By regulation, Medicaid is designated as the payor of last resort.
Using incorrect transportation codes for ambulette service.
Billing for ambulette transport while the patient was a hospital inpatient.

In 2005, as a member of the Ohio House of Representatives, Taylor sponsored legislation granting the State Auditor discretionary authority to audit individual Medicaid providers. Medicaid provides health coverage to families with low incomes, children, pregnant women, and people who are aged, blind or have disabilities.

A copy of the complete report is available online at www.auditor.state.oh.us

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Contact
Steve Faulkner
Deputy Press Secretary
614/644-1111

Taylor’s Medicaid Reform Suggestions Included in Senate Budget Redraft

Fri, 29 May 2009 12:00:00 -0400

Columbus -

Auditor of State Mary Taylor today said the inclusion of several Medicaid reform recommendations in the Ohio Senate’s version of the biennium budget, based on the work of her performance auditing staff, could result in more than $100 million in annual savings while improving the overall effectiveness of the program.

Since taking office, Taylor has advocated for adoption of the Medicaid performance audit recommendations to cut costs and improve the efficiency and effectiveness of the Medicaid program – the largest single component of the state’s biennial operating budget.

In fact, Taylor commissioned a follow-up report for the 2006 Medicaid performance audit, released in December 2008, which indicated almost half of the recommendations to reduce costs and improve the Medicaid program have not been implemented.

“I will continue to advocate for reform recommendations that will make Ohio’s Medicaid program more efficient and effective,” Taylor said. “These suggestions in the Senate substitute bill will create program improvement opportunities and provide significant cost savings at a time when we need it the most. I am pleased to work with the Ohio Senate and contribute practical solutions as we move forward in the state budget process.”

The Senate’s version of the state’s biennium budget includes eight recommendations from a comprehensive performance audit of the Medicaid program released by the Auditor of State’s office in December 2006. Three of the recommendations result in annual savings of more than $100 million. They are:

• Full implementation of a statewide E-prescribing program – $62.2 million
• Implementation of a disease management program for certain Medicaid recipients – $54 million
• Coordination of benefits for Medicaid recipients who also belong to a private health insurance plan – $6 million

The five remaining recommendations included in the Senate budget from the Auditor of State’s performance audit would result in improvements to management efficiencies as well as patient care.

As a state legislator in 2005, Taylor introduced a measure that was included in the state’s biennial budget bill directing the Auditor of State to conduct a performance audit of Medicaid.

The initial performance audit, released in December 2006, provided the incoming administration with 109 recommendations to improve Ohio’s Medicaid program and cut costs without harming critical services. The original recommendations, if fully implemented, had the potential to save taxpayers more than $400 million annually.

A subsequent Medicaid status report update, released by Taylor in December 2008, identified 54 recommendations – totaling more than $302.8 million in annual savings – that have not been implemented.

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The Ohio Auditor of State’s office is one of the largest accounting offices in the nation. The office strives to ensure that all public funds are spent legally and appropriately and works aggressively to root out fraud, waste and abuse in public spending. Taylor encourages anyone suspecting fraud or misspending of public dollars to contact her office toll free at 866-FRAUD-OH (866-372-8364). Since taking office, Taylor has identified more than $20.4 million in public funds that were handled improperly, spent illegally or stolen and must be repaid.

Taylor: Scioto County Medicaid Provider Owes State More Than $430,000

Thu, 21 May 2009 12:00:00 -0400

Scioto County -

Auditor of State Mary Taylor today released the audit of Life Ambulance Services, Inc. and announced that the Portsmouth-based Medicaid service provider owes the state more than $430,000.

The report finds that the ambulance company, which also provides transportation to wheelchair-bound patients by ambulette, submitted inappropriate and erroneous claims to the state’s Medicaid program for reimbursement. As is standard practice for all Medicaid provider audits, Taylor is forwarding her report to the Ohio Attorney General’s Medicaid Fraud Control Unit for further review.

“I will not tolerate the waste and abuse of public tax dollars,” said Taylor. “Medicaid providers who take advantage of the state’s billing system and fail to follow state law will be held accountable.”

Taylor’s office tested more than 120,000 separate services submitted for reimbursement by Life Ambulance during a three year period – April 1, 2003 to March 31, 2006. From a total of nearly $4.8 million in claims, the audit identifies $352,663.83 in improper claims submissions as well as $81,779.36 in interest owed to the state.

The audit reveals that several claims filed by Life Ambulance for reimbursement were inappropriate and likely the result of poor recordkeeping and management practices. Problems identified include:

Claims lacking any supporting documentation that the service was ever provided
Ambulance services billed to Medicaid that should have been billed to Medicare
Duplicate claims submitted for the same patient on the same date for the same destination
Claims billed for mileage greater than that supported by documentation

In 2005, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor discretionary authority to audit individual Medicaid providers. Prior to that, Medicaid providers were audited only at the request of the Ohio Department of Job and Family Services.

Medicaid provider audits are a component of Taylor’s comprehensive approach to improving the efficiency and effectiveness of Ohio’s Medicaid program. Medicaid is currently the largest program in state government.

Taylor continues to call upon state policymakers to implement the recommendations outlined in a comprehensive performance audit of Medicaid released in 2006. In December 2008, she released an update to the Medicaid performance audit that shows the state’s Medicaid program remains a complex and costly bureaucracy. The follow-up reveals more than $300 million in potential annual saving recommendations that have not been implemented.

A copy of the complete audit is available online at www.auditor.state.oh.us.

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$122.2 Million in Medicaid Savings Overlooked

Wed, 29 Apr 2009 12:00:00 -0400

Columbus -

Auditor of State Mary Taylor today said ideas to improve the efficiency and effectiveness of Ohio’s Medicaid program and save hundreds of millions of dollars in the process continues to be overlooked by state policy makers at a time when Ohio’s budget is in distress.

Members of the Ohio House disregarded a proposal to implement several recommendations from the Auditor of State’s Medicaid Performance audit with potential savings to Ohio taxpayers of $122.2 million annually.

“I have been asked, ‘What would you cut?’ to solve the state’s budget crisis,” Taylor said. “Since I took office, I have discussed practical solutions and proven practices from the Medicaid Performance audit that could result in hundreds of millions in program savings. Unfortunately my solutions to save tax dollars and make Medicaid more efficient and effective continue to be ignored.”

The proposal, offered as an amendment to the state budget by Representative Barbara Sears (R-Sylvania), includes eight Medicaid performance audit recommendations. Three of those recommendations would result in annual savings of $122.2 million. They are:

Full implementation of a statewide E-prescribing program – $62.2 million
Implementation of a disease management program for certain Medicaid recipients – $54 million
Coordination of benefits for Medicaid recipients who also belong to a private health insurance plan – $6 million

The five remaining recommendations from the Auditor of State’s performance audit would result in improvements to management efficiencies if implemented.

As a state legislator in 2005, Taylor introduced a measure that was included in the state’s biennial budget bill directing the Auditor of State to conduct a performance audit of Medicaid.

The initial performance audit, released in December 2006, provided the incoming administration with 109 recommendations to improve Ohio’s Medicaid program and cut costs without slashing critical services. The original recommendations, if fully implemented, had the potential to save taxpayers more than $400 million annually.

A subsequent Medicaid status report update, released by Taylor in December 2008, identified 54 recommendations – totaling more than $302.8 million – that have not been implemented.

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Taylor: Cincinnati Medicaid Provider Owes State More Than $680,000

Thu, 19 Feb 2009 12:00:00 -0400

Cincinnati -

Auditor of State Mary Taylor today released the audit of Hometowne Transportation, LLC and announced that the Cincinnati-based Medicaid service provider owes the state more than $680,000.

The report finds that the ambulette company, which provides transportation to wheelchair-bound patients, submitted inappropriate and potentially fraudulent claims to the state’s Medicaid program for reimbursement. Taylor is forwarding her report to the Ohio Attorney General’s Medicaid Fraud Control Unit for further review.

“I will not tolerate the fraud, waste and abuse of public tax dollars,” said Taylor. “Medicaid providers who take advantage of the state’s outdated billing system and fail to follow state law will be held accountable. When my office identifies Medicaid providers who commit fraud, we will do everything we can to ensure they no longer do business with the state of Ohio.”

Taylor’s office tested more than 20,000 separate reimbursement claims submitted by Hometowne during a three year period – April 1, 2003 to March 31, 2006. From a total of nearly $1.3 million in claims, the audit identifies $565,088 in improper submissions as well as $119,767 in interest owed to the state.

Auditors identified 5,443 claims in which Hometowne Transportation improperly billed the state for “attendant services.” Essentially, the provider was billing Medicaid for family members, friends or nursing home aides traveling with the patient as if they were additional employees of Hometowne.

Other inappropriate and potentially fraudulent claims submitted to the state include:

• Duplicate claims – identical claims submitted for identical services conducted on identical dates
• Improperly billed mileage – claims submitted where the mileage billed exceeded the provider’s own odometer readings
• Billing for services after the date a patient had died – claims dated for services said to have been provided after the date of a patient’s death

Taylor’s review of Hometowne also included a thorough review of employee files to determine compliance with driver and vehicle requirements outlined in state law.

The audit indicates that some employees lacked:

• Required medical training such as CPR certificates
• Criminal background checks
• Periodic reviews of driving records

The failure of transportation providers to comply with state law places patients in harm’s way and could jeopardize Hometowne’s status with the Medicaid program as a provider.

In 2005, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor discretionary authority to audit individual Medicaid providers. Prior to that, Medicaid providers were audited at the request of the Ohio Department of Job and Family Services.

Medicaid provider audits are a component of Taylor’s comprehensive approach to improving the efficiency and effectiveness of Ohio’s $13 billion Medicaid program. Medicaid consumes 37 percent of the state budget – more than any other taxpayer funded government program.

Taylor continues to call upon state policymakers to implement the recommendations outlined in a comprehensive performance audit of Medicaid released in 2006. In December, she released an update to the Medicaid performance audit that shows the state’s Medicaid program remains a complex and costly bureaucracy. The follow-up revealed more than $300 million in potential annual savings that remains left on the table.

A copy of the complete audit is available online at http://www.auditor.state.oh.us/AuditSearch/Reports/2009/A_9_Hometowne_Final_Report_020309.pdf .

Taylor Follows Up on Status of Medicaid Performance Audit Recommendations

Thu, 18 Dec 2008 12:00:00 -0400

Columbus -

Auditor of State Mary Taylor today released a progress report on the status of the recommendations outlined in the 2006 performance audit of the state’s taxpayer-funded Medicaid program. The report reveals that the program could still potentially save taxpayers more than $300 million annually.

“This report is clear: true reform is going to require a long-term, forward-thinking approach to restructure and improve Ohio’s Medicaid program,” Taylor said. “We have provided Ohio’s policy-makers with the tools, now it’s up to them to get the job done.”

As a state legislator in 2005, Taylor introduced a measure that was ultimately included in the state’s biennial budget bill directing the Auditor of State to conduct a performance audit of Medicaid.

The initial performance audit, released in December 2006, provided the incoming administration with 109 recommendations to improve Ohio’s Medicaid program and cut costs without slashing critical services. The original recommendations, if fully implemented, had the potential to save taxpayers more than $400 million.

The Medicaid status report update released today identifies 15 recommendations for improvement that are fully implemented. Another 40 recommendations are partially implemented, while the remaining 54 recommendations – totaling more than $302.8 million – are not implemented. Some key points in the recommendations reveal:

Medicaid lacks long-term vision
Reorganization of Medicaid, based on a forward-thinking, long-range approach as outlined in audit recommendations 3.1, 3.6 and 3.12 could save the state $156.5 million annually.
The increased use of generic prescription drugs will save tax dollars
Ohio has achieved a generic drug dispensing rate of roughly 60 percent while other states, including some of our neighbors, have achieved a generic drug dispensing rate of more than 67 percent. Because costs can be reduced at a rate of $19 million for every one percent of improvement, Ohio could potentially save $128 million annually with a generic dispensing rate of 67 percent – a number Utah, Illinois and Kentucky achieved at the 67 percent rate.
Full implementation of an e-prescribing program can save tax dollars
E-prescribing could save the state as much as $5 million monthly. E-prescribing is the use of hand-held electronic devices by doctors writing patient prescriptions. It has the ability to identify lower priced generic drugs covered by Medicaid and will help warn doctors and patients of potentially harmful drug interactions. Mississippi’s e-prescribing pilot program has resulted in $1.9 million in monthly savings. Florida has had similar success.

The report indicates that the purpose of the follow-up performance audit is to provide Ohio’s policy makers with information for use during the upcoming state budget deliberations. The recommendations outlined in the report could provide an opportunity to make the Medicaid program more efficient and effective while reducing costs and maintaining vital services for recipients.

A copy of the complete report is available online at www.auditor.state.oh.us.

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Taylor Audit Exposes More Than $308,000 Improperly Billed by Circleville Medicaid Provider

Tue, 07 Oct 2008 12:00:00 -0400

Circleville -

Auditor of State Mary Taylor today released the Medicaid provider audit of Pickaway Plains Ambulance Service, Inc. The audit reveals that the Circleville medical transportation provider may owe the Ohio Department of Job and Family Services (ODJFS) $308,822.09 for improperly billed Medicaid services and $62,475.13 in accrued interest.

“Medicaid providers in the state must be held accountable for the public money they spend,” Taylor said. “My office will continue to look for ways to improve the program’s efficiency and effectiveness, while ensuring providers are not wasting or abusing the taxpayers’ money.”

The audit reviews Medicaid services billed to ODJFS from January 1, 2003 through December 31, 2005. The audit shows that Pickaway Plains Ambulance Service, Inc. improperly billed Medicaid $308,822.09 for ambulance and ambulette transportation services during the two-year audit period. Furthermore, the provider failed to comply with various Medicaid rules, resulting in overpayments. Some of the more notable practices that led to the overpayments include:

• Billing for transportation services that are not covered by Medicaid.
• Incorrectly billing ambulette services as ambulance services, which are paid at a higher rate.
• Charging for services twice when only one service was performed.
• Billing for services that did not have the necessary supporting documentation, including missing or incomplete Certificates of Medical Necessity (CMN). CMNs are the transportation equivalent of a doctor’s prescription and ensure that the transports provided are for a medically necessary purpose.
• Billing for transports longer than 50 miles without appropriate justification. The Medicaid program requires that providers document a reason for taking a patient out of their community.
• Billing transportation services with overstated mileage.
• Separately billing Medicare and Medicaid as primary insurers for the same transports for those patients who are eligible under both systems.
• Billing Medicaid for Medicare-covered services. By regulation, Medicaid is designated as the payor of last resort.

In 2005, as a member of the Ohio House of Representatives, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor discretionary authority to audit individual Medicaid providers. Medicaid provides health coverage to families with low incomes, children, pregnant women, and people who are aged, blind or have disabilities.

Taylor has referred the findings to ODJFS. As the state agency charged with administering the Medicaid program in Ohio, it is the responsibility of ODJFS to make any final determinations regarding recovery.

A full copy of the report is available online at www.auditor.state.oh.us.

Taylor Audit Exposes $1.1 Million Owed to State by Medicaid Provider

Tue, 22 Apr 2008 12:00:00 -0400

Columbus -

Auditor of State Mary Taylor today released the Medicaid provider audit of Access Transit Company. The audit reveals that the Columbus medical transportation provider owes the Ohio Department of Job and Family Services (ODJFS) $1,152,801.21 for improperly billed Medicaid services and $234,981.95 in accrued interest.

“Medicaid providers in the state must be held accountable for the public money they spend,” Taylor said.

The audit reviewed Medicaid services billed to ODJFS from October 1, 2002 through September 30, 2005. The audit reveals that Access Transit Company improperly billed Medicaid $1,152,801.21 for ambulette and ambulance services. In addition to many documentation errors, the audit shows that Access Transit Company inappropriately billed Medicaid for duplicate services, services not covered by the program, deceased patients and incorrect mileage. The audit report also noted that the provider lacked the required number of EMT personnel on various ambulance transports.

Access Transit Company discontinued operations on December 18, 2006 and was terminated as a Medicaid provider. The business owner passed away on February 10, 2008.

In 2005, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor discretionary authority to audit individual Medicaid providers. Medicaid provides health coverage to families with low incomes, children, pregnant women, and people who are aged, blind or have disabilities. Since taking office in January 2007, Taylor has identified more than $2.7 million in Medicaid funds that were inappropriately utilized.

A full copy of the report is available online at http://www.auditor.state.oh.us/AuditSearch/Reports/2008/Access_Transit_Company_Franklin_Final_04-15-08.pdf.

Taylor Audit Exposes $60,000 Owed to State by Medicaid Provider

Wed, 20 Feb 2008 12:00:00 -0400

Columbus -

Auditor of State Mary Taylor today released the Medicaid provider audit of Regency Manor Rehabilitation. The audit reveals that the long-term care provider owes the Ohio Department of Job and Family Services (ODJFS) $58,540.97 for improperly billed Medicaid services and $2,674.35 for accrued interest.

“Medicaid providers in the state must be held accountable for the public money they spend. These funds should be protected by rigorous checks and balances to prevent mistakes in the future,” Taylor said.

The audit reviewed Medicaid services billed to ODJFS from July 1, 2004 through June 30, 2005. The audit reveals that Regency Manor Rehabilitation improperly billed Medicaid $40,437.50 for patient room and board services and $18,103.47 for therapy services. As a result, the provider now owes ODJFS $58,540.97 for billing errors.

Taylor has referred the findings to ODJFS, which is responsible for adjudicating any findings the provider feels are inaccurate or have already been repaid. Further, as the state agency charged with administering the Medicaid program in Ohio, ODJFS will make the final determination regarding recovery of the findings once adjudicated.

The provider did not supply a written response for inclusion in the final audit report but has communicated its plans to work with ODJFS regarding the audit findings. Additionally, ODJFS recently established a direct billing process which should help Medicaid providers avoid billing mistakes.

A full copy of the report is available online at http://www.auditor.state.oh.us/AuditSearch/Reports/2008/A_8_Regency_Manor_Final_Report_to_COB.pdf.

Taylor Says Cincinnati Nursing Facility Incorrectly Billed the State More Than $287,000

Thu, 11 Oct 2007 12:00:00 -0400

Cincinnati -

State Auditor Mary Taylor released the Medicaid provider audit of a Cincinnati based nursing facility today. The audit of Burlington House indicates the provider incorrectly billed the Ohio Department of Job and Family Services (ODJFS) more than $287,000 in room and board and therapy services.

“Medicaid providers must review billing statements to ensure that public funds are spent legally and appropriately,” Taylor said. “The failure to do so increases the potential of misspending or outright fraud and could jeopardize the funding of a program serving some of the state’s most vulnerable citizens.”

The total amount Burlington House may owe the state is $287,545.61. The audit reveals that 160 claims, 134 claims for room and board and 26 claims for therapy services, filed by Burlington House for reimbursement contained billing errors. The errors include:

Certain claims paid at 100 percent that should have been reimbursed at 50 percent
Claims that should have been charged to Medicare instead of Medicaid
Claims that should have been charged to private insurance companies rather than Medicaid
Claims billed to Medicaid when patients were not even living in the facility at that time
Therapy claims where the units performed were over billed

The audit reviewed Medicaid reimbursements made to Burlington House from July 1, 2004 through December 31, 2005 for room and board as well as therapy services. During this period, Burlington House was reimbursed a total of $5,187,109.09 for 1,234 Medicaid claims.

According to the audit, nursing home facilities account for 22 percent of all Medicaid expenditures making it the number one category of Medicaid expenses. Prescription drugs, the second largest expenditure category, account for 17 percent of Ohio’s Medicaid expenditures.

Taylor has referred the findings to the Ohio Department of Job and Family Services. As the state agency charged with administering the Medicaid program in Ohio, it is the department’s responsibility to make any final determinations regarding recovery. Under Ohio law, amounts due to the state must be paid within 45 days of a determination, after which time the matter is referred to the Ohio Attorney General for collection.

In 2005, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor the discretionary authority to audit individual Medicaid providers. Medicaid provides health coverage to low income families, children, pregnant women, and people who are aged, blind, or have disabilities. Medicaid is administered by ODJFS.

This is the second Medicaid provider audit released under the new authority of the State Auditor. The first audit reviewed Medicaid payments made to Toledo based Brookeside Ambulette. That audit uncovered nearly $600,000 in possible Medicaid overpayments, duplicate claims and claims submitted for services provided to deceased patients.

The Ohio Auditor of State’s Office is one of the largest accounting offices in the nation. The office strives to ensure that all public funds are spent legally and appropriately and works aggressively to root out fraud, waste and abuse in public spending. Taylor encourages anyone suspecting fraud or misspending of public dollars to contact her office toll free at 1-866-FRAUD-OH (1-866-372-8364).

A full copy of the audit is available online at www.auditor.state.oh.us.

Taylor Hosts Medicaid Reform Discussions

Tue, 25 Sep 2007 12:00:00 -0400

Cincinnati -

State Auditor Mary Taylor held a roundtable discussion today for Medicaid stakeholders to discuss the recommendations made by the performance audit. More than $13 billion is spent each year on Ohio’s Medicaid program, making it the largest single program in state government. The Medicaid Performance Audit, which was released in December 2006, made more than 100 recommendations that if implemented could save the program more than $400 million annually.

“I am eager to receive feedback from Ohioans about the Medicaid Performance Audit and its recommendations,” said Taylor. “Currently, the Medicaid system is fraught with inefficiencies and is a major drain on Ohio taxpayer dollars. I am committed to keeping the momentum moving forward on changes to Medicaid and the performance audit is a logical starting point for comprehensive reform.”

In 2005, as a legislator, Taylor introduced a bill in the Ohio House of Representatives granting the State Auditor the authority to conduct a one-time performance audit of Ohio’s Medicaid program. Taylor says the Medicaid Performance Audit is a thorough analysis of the operations of the system.

Today’s event is the last in a series of Medicaid roundtable discussions. Previous discussions were held in Columbus and Canton.

For more information about the State Auditor’s Office, please visit: www.auditor.state.oh.us.