Advertisement
An audit released in August estimated state and federal taxpayers paid between $694,000 and $1.65 million in 2005 alone for improper Medicaid transportation in Milwaukee County.
As a result of the audit, the state of Wisconsin was forced in September to repay $347,000 to the federal government for the improper payments. However, the state has declined to attempt to recover state tax money that was spent improperly, a spokeswoman said Friday.
Auditors estimated up to 20 percent of nearly 400,000 claims made by Milwaukee-based American United Taxicab Co. in 2005 were to transport people who received no treatment through Medicaid on the day they received rides.
Under the state-federal health care program for low-income, disabled and elderly, states are required to pay transportation expenses for recipients receiving non-emergency medical treatment.
American United is the biggest transportation provider in Milwaukee County, receiving $6.3 million for services in 2005, the audit report by U.S. Health and Human Services found.
The company’s general manager, Red Christensen, said drivers provided the rides in every instance it received payments. But he said some of the clients told drivers they were going to the doctor when they actually needed transportation to run errands.
“They were using the service to go to clinics located near strip malls, or Wal-Mart or other places,” Christensen said. “They were booking the rides and then fraudulently misusing the service. ... It’s what I call the abuse factor.”
In the most obvious cases, he said clients showed up for rides with bags of laundry. Others routinely claimed they needed to pick up prescriptions at Wal-Mart, but never did and went shopping instead, he said.
Auditors reviewed 100 claims paid to the company in 2005 and found 20 instances in which they were unable to find documentation showing the recipients received medical treatment.
Christensen said the company had notified health maintenance organizations who run Medicaid of abuses but in general “it’s not our place to police it.”
The audit criticized Milwaukee County and the HMOs for having weak controls that failed to detect the abuse and recommended they implement tighter ones.
Dennis Buesing, a county contract administrator, said there were valid reasons for people to get free rides on days when they claimed no Medicaid treatment. Those include picking up prescriptions or getting medical treatment paid for by other sources, he said.
“That’s not to say there was not some abuse of the system,” he said.
Neither the state nor federal government gave his agency a copy of the audit or a chance to respond, Buesing said. He said he would need more information about the claims reviewed by auditors to say whether it was a valid study.
Wisconsin Department of Health Services spokeswoman Stephanie Smiley said the state has decided not to try to recover its share of improper payments from HMOs or the county. Those were estimated by the audit at $347,000 or more.
“The costs of pursuing recovery of these funds could be better used toward implementing improvements to the system,” she said in an e-mail.
She said beginning next year, the state will pay HMOs in Milwaukee County a set amount to cover transportation costs. The HMOs will assume financial risk for the services and be responsible for overseeing them.
HMOs currently pay for transportation claims on a fee-for-service basis and then are reimbursed by state and federal taxpayers for those costs.
The changes should help eliminate fraud by giving HMOS an incentive to better monitor claims, Smiley said. However, she said some of the problems “could be due to clerical errors or poor documentation.”
Families of three with incomes of less than $32,000 generally qualify for Medicaid in Wisconsin, according to the Kaiser Family Foundation, which tracks state medical programs.
