Columbus – A Cuyahoga County ambulette company owes the state $109,668 after a Medicaid examination found incomplete documentation and services provided by unqualified drivers. 

The review of Physicians Ambulance Service, Inc. found 668 errors among 829 transportation services provided between Jan. 1, 2012 and Dec. 31, 2014, resulting in overpayments totaling $107,121. The provider received $734,703 in reimbursements for 32,881 services during the period. With $2,547 in interest, the provider owes the Ohio Department of Medicaid $109,668.

During a review of certificates of medical necessity (CMN), which are required for service authorization, auditors identified 89 errors that resulted in overpayments. These included 58 transports with CMNs that did not certify that recipients met any criteria for medical necessity, did not include a medical condition, did not include the name of a provider or were not signed by an authorized practitioner. Another 27 services lacked CMNs to cover the transports. 

After receiving a final request for records from auditors, the provider submitted numerous CMNs, some of which contradicted those previously supplied for the same recipients and dates of service. According to the report, “The (provider’s) focus appears to be on obtaining multiple CMNs rather than ensuring a valid CMN is on file for each transport.”

“Complete documentation can be the difference between a clean audit and a $100,000 finding,” Auditor Yost said. “A good quality control process could have saved this provider a lot of headache.”

Auditors also reviewed personnel files for six drivers hired during the review period and found several instances where drivers did not meet hiring requirements including the completion of drug and alcohol tests, criminal background checks and passenger assistance training, or failed to do so in a timely manner. 

Additionally, the examination identified four drivers among 12 tested with lapses in both first aid and CPR certification. A total of 45 transports were provided by ineligible drivers. 

A full copy of this report is available 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 5,900 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.

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