Auditor of State Mary Taylor today released the Medicaid provider audit of LifeStar Ambulance, Inc. The audit reveals that the Toledo-based medical transportation provider owes the Ohio Department of Job and Family Services (ODJFS) $157,719.24 for improperly billed Medicaid services and $26,168.43 in accrued interest. LifeStar repaid the entire amount at the end of September.
“Our audit staff is making an impact on the Medicaid system by holding providers accountable for the services they provide. Our audit work successfully identified inappropriate billing practices used by LifeStar Ambulance. In response to our audit findings, LifeStar reimbursed every penny owed to the Medicaid system,” Taylor said. “My office will continue to work to make sure all public funds are spent legally and appropriately and as the law requires.”
The audit reviewed Medicaid services billed to ODJFS from April 1, 2004 through March 31, 2007. The audit shows that LifeStar Ambulance, Inc. improperly billed Medicaid $159,205.97 for ambulance and ambulette transportation services during the three-year audit period. During the course of the audit the provider repaid $1,486.73, bringing the overall finding for recovery total to $157,719.24.
Furthermore, the provider failed to comply with various Medicaid rules, resulting in overpayments. Some of the more notable practices that led to the overpayments include:
- Billing for transports longer than 50 miles without appropriate justification. The Medicaid program requires that providers document a reason for taking a patient out of their community.
- Charging for services twice when only one service was performed.
- Billing for services that did not have the necessary supporting documentation, including missing or incomplete Certificates of Medical Necessity (CMN). CMNs are the transportation equivalent of a doctor’s prescription and ensure that the transports provided are for a medically necessary purpose.
- Billing transportation services with overstated mileage.
- Billing both Medicaid and Medicare for the same ambulance services.
- Billing Medicaid for Medicare-covered services. By regulation, Medicaid is designated as the payor of last resort.
- Using incorrect transportation codes for ambulette service.
- Billing for ambulette transport while the patient was a hospital inpatient.
In 2005, as a member of the Ohio House of Representatives, Taylor sponsored legislation granting the State Auditor discretionary authority to audit individual Medicaid providers. Medicaid provides health coverage to families with low incomes, children, pregnant women, and people who are aged, blind or have disabilities.
A copy of the complete report is available online at www.auditor.state.oh.us
Deputy Press Secretary