Columbus – More than $448,000 in improper Medicaid payments have been made to Integrity Ambulance Service, LLC (Darke County) as a result of transportation services being provided without proper authorization, according to an examination released today by Auditor of State Dave Yost.

Findings from the examination of the non-emergency medical transportation services showed that during the period of July 1, 2011 through June 30, 2014, Integrity Ambulance Service, LLC was overpaid by $448,428. With interest in the amount of $29,666, the provider owes the Ohio Department of Medicaid (ODM) $478,094.

Auditors tested 862 transports in three statistical samples and identified 227 services in which there was no certificate of medical necessity to cover the date of service, which is required for service authorization. Additionally, the audit found 241 transports in which the applicable certificate did not certify the recipients met any criteria for medical necessity, did not include a medical condition and/or were not signed by an authorized practitioner. 

In addition, a review of trip documentation found overpayments as a result of the following 32 errors:

• 10 transports with no trip documentation;
• 7 transports in which the miles billed exceed the miles documented;
• 6 transports for which it could not be determined if one point was to a Medicaid covered service;
• 4 transports by an ineligible driver; 
• 3 transports in a vehicle prior to it being licensed; and
• 2 cancelled trips without required documentation for a cancelled trip.

“Rules governing the use of Medicaid wheelchair van services are designed to ensure patient safety and proper reimbursements,” Ohio Auditor Dave Yost said. “Complying with driver qualifications, service documentation and service authorization, among other requirements, are non-negotiable.”

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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Beth Gianforcaro
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614-644-1111