A failure to track Medicaid patients’ use of publicly financed transportation has left the D.C. government with only a vague idea of how many people use the service, or if their conditions justify the type of transportation provided, a new report finds.
The D.C. Inspector General determined that the Department of Health’s Medical Assistance Administration “did not maintain Medical Necessity forms for nearly all of the 8,607 participants who received transportation benefits at a cost of $16.3 million” in fiscal 2005.
The Inspector General report was part of a continuing series of audits on the department’s nonemergency transportation of Medicaid recipients.
The Medical Necessity forms are used to validate a recipient’s medical condition and to justify various modes of transportation.
Without the forms, the report states, the health department “cannot determine the total number of authorized participants” in the transportation program, and “cannot substantiate the medical condition that warranted transportation for program participants.”
In other words, auditors have no way of knowing whether the District is spending too much to transport patients.
Under federal law, the District is required to provide Medicaid patients with transit to the doctor. But only with the Medical Necessity forms — which must be filled out at a medical facility, signed by a physician and delivered to the administration — can the District determine what mode of transportation is appropriate and cost-effective for a patient.
The forms could also show that too many people are using vans, the most expensive mode of transportation. The District used 225 transportation providers in fiscal 2005 for its nearly 9,000 patients, spending $1,895 per participant — or $38.12 per claim.
But the administration maintained only 292 Medical Necessity forms for the entire year, according to the IG.
In its response, the Department of Health agreed to create a filing system and review the entire program on a quarterly basis.
The administration is “optimistic about its ongoing implementation of new operational controls and is deeply committed to working to resolve these issues as soon as possible,” Dr. Gregg Pane, health department director, wrote in his agency’s response to the audit.
An earlier audit of the nonemergency transportation program found a District procurement official bypassed the contracting process and simply signed off on a $963,000 contract for dispatch services. The next audit will be a review of the transportation providers.
The IG’s recommendations
» Immediately establish organized filing system for necessity forms
» Ensure the District receives appropriate forms from medical facilities
» Conduct monthly reviews
