Transcription
4/14/2016Non-EmergencyMedical TransportationPresentationLearning Objectives Identify general Medicaid-covered non-emergency medicaltransportation (NEMT) benefits Identify methods States can use to authorize availableNEMT options Identify common medical transportation fraud and abuse issuesCenters for Medicare & Medicaid Services2Non-Emergency MedicalTransportation DefinedUnder Federal law, State Medicaidagencies (SMAs) must: Ensure necessary transportationto and from providers Use the most appropriate formof transportation Include coverage for transportationand related travel expensesnecessary to attend medicalappointmentsCenters for Medicare & Medicaid Services31
4/14/2016Unmet Transportation NeedUnmet transportation needs can include: Not having a valid driver’s license Not having a working vehicle available in the household Not being able to drive because of a medical condition Other situations, such as no money for gas4Centers for Medicare & Medicaid ServicesEmergency Transportation Is Different Medical needs are immediate Symptoms may be due to a serious event(for example, automobile accident)Symptoms are severeSymptoms may be life-threatening (forexample, heart attack)5Centers for Medicare & Medicaid ServicesState Rules for Non-EmergencyMedical Transportation Centers for Medicare & Medicaid ServicesMay vary by StateRequire providers tohave a Medicaid contract62
4/14/2016State Rules for Non-EmergencyMedical Transportation—Continued Loaded mileage—beneficiary must bein the vehicle Appropriate locationWait times are not usually reimbursable7Centers for Medicare & Medicaid ServicesTypes of Transportation Wheelchair vansTaxisStretcher carsBusesOther SMAapproved transportationCenters for Medicare & Medicaid Services8Knowledge CheckFor a transportation provider to receivereimbursement for furnished services, atransported beneficiary must:A. Have his or her own carB. Be ineligible for MedicaidC. Be eligible for MedicaidD. Take an ambulanceCenters for Medicare & Medicaid Services93
4/14/2016Transportation Entities StatesBrokersManaged care plansTransportation companies10Centers for Medicare & Medicaid ServicesTransportation DriversDrivers must be: Licensed Qualified Competent Courteous11Centers for Medicare & Medicaid ServicesQualified Vehicles Centers for Medicare & Medicaid ServicesProof of ownershipLegally licensedCurrent license platesSafeWell-maintainedLiability insurance124
4/14/2016Knowledge CheckTrue or False?State Medicaid transportation servicescan only be furnished by the State.Centers for Medicare & Medicaid Services13Fraud and Abuse inMedical TransportationMost transportation providers want to do the right thing.Those providers: Bill claims properlyFollow Medicaid rulesUnderstand fraud schemesTake time to learn preventive strategiesCenters for Medicare & Medicaid Services14Fraud and Abuse in MedicalTransportation—FraudA Medicare beneficiary: Drove himself and others to dialysis appointments,but allowed an ambulance company owner to bill forambulance rides with their medical IDs Received kickbacks for referring patients to theambulance companyAn owner of a Massachusetts medical transportation company: Billed for rides for deceased beneficiariesWas sentenced to 18 months in prison and ordered torepay over 475,000Centers for Medicare & Medicaid Services155
4/14/2016Fraud and Abuse in MedicalTransportation—AbuseTwo ambulance companies in Connecticut: Allegedly provided ambulance transportation fordialysis patients who did not have a medical needfor ambulance transportation Paid almost 600,000 to settle these allegationsCenters for Medicare & Medicaid Services16Fraud Scheme—Services Not Rendered Not all NEMT fraud is perpetrated byprofessional providers The parent of a patient: Was authorized to transport her childfor treatment Billed Medicaid for trips that did nottake place Was sentenced to 30 days in jail andordered to pay 21,500Centers for Medicare & Medicaid Services17Fraud Scheme—Services Not Rendered NEMT company owner billed for cancelled trips, used beneficiaryinformation without permission to bill for services never provided,and upcoded trips Transportation company upcoded regular livery services asambulette services; 300,000 settlementCenters for Medicare & Medicaid Services186
4/14/2016Fraud Scheme—VehiclesOwner of a transportation companyforged forms that authorized taxitransportation to show moreexpensive ambulette transportation; 200,000 settlementCenters for Medicare & Medicaid Services19Fraud Schemes—Travel VouchersTaxi driver: Accepted Medicaid vouchers fornonmedical locations Purchased unused vouchers Charges exceeded actual services Lifetime exclusionCenters for Medicare & Medicaid Services20Unqualified Drivers andOther Fraud Schemes Company whose owner falsified drivers’ documentation wasfined 10,000 Other transportation fraud schemes include: Billing for personal assistance when none was provided Coding all 911-dispatched city ambulances atthe advanced life support rate regardless of thebeneficiary’s conditionCenters for Medicare & Medicaid Services217
4/14/2016Tips for Preventing MedicalTransportation Fraud Document what the State wantsVerify documented servicesBill correctlyCenters for Medicare & Medicaid Services22Tips for Preventing MedicalTransportation Fraud—DocumentationFollow State documentation requirements. At a minimum include: Beneficiary’s name Medicaid identifier Locations of pickup and drop-off Date and time of pickup and drop-off Loaded mileageCenters for Medicare & Medicaid Services23Tips for Preventing MedicalTransportation Fraud—Verify ServicesIt is management’s responsibility to: Verify information Make random survey callsCenters for Medicare & Medicaid Services248
4/14/2016Tips for Preventing Medical TransportationFraud—Billing AccuratelyForm CMS-1500 includes a notice thatfiling a false claim may lead to: Criminal penalties Civil penaltiesCenters for Medicare & Medicaid Services25Final Action—Check for Excluded Individuals and Parties Use the List of Excluded Individuals andEntities (LEIE) Use the System for Award Management(SAM) Exclusions Extract Check monthlyCenters for Medicare & Medicaid Services26Report It! SMA and Medicaid Fraud Control tion/fraudprevention/fraudabuseforconsumers/report fraud and suspected fraud.html U.S. Department of Health and Human Services, Office ofInspector General (HHS-OIG)Phone: 1-800-447-8477 (1-800-HHS-TIPS)TTY: 1-800-377-4950Fax: 1-800-223-8164Email: HHSTips@oig.hhs.govWebsite: https://forms.oig.hhs.gov/hotlineoperationsCenters for Medicare & Medicaid Services279
4/14/2016ConclusionWe are all enlistedto prevent fraudand abuse!28Centers for Medicare & Medicaid ServicesQuestionsPlease direct questions or requests to:MedicaidProviderEducation@cms.hhs.govTo see the electronic version of thispresentation and the other productsincluded in the “Non-Emergency MedicalTransportation” Toolkit, visit the MedicaidProgram Integrity Education page ic-landing.html onthe CMS website.Follow us on Twitter#MedicaidIntegrityCenters for Medicare & Medicaid Services29DisclaimerThis presentation was current at the time it was published or uploadedonto the web. Medicaid and Medicare policies change frequently so linksto the source documents have been provided within the document foryour reference.This presentation was prepared as a service to the public and is notintended to grant rights or impose obligations. This presentation maycontain references or links to statutes, regulations, or other policymaterials. The information provided is only intended to be a generalsummary. Use of this material is voluntary. Inclusion of a link does notconstitute CMS endorsement of the material. We encourage readers toreview the specific statutes, regulations, and other interpretive materialsfor a full and accurate statement of their contents.April 2016Centers for Medicare & Medicaid Services3010
Fraud and Abuse in Medical Transportation—Fraud A Medicare beneficiary: Drove himself and others to dialysis appointments, but allowed an ambulance company owner to bill for ambulance rides with their medical IDs Received kickbacks for referring patients to the ambulance company An owner of a Massachusetts medical transportation .
