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Senate seeks Medicaid review

By Jim McElhatton

The Washington Times

November 22, 2006

The Senate Finance Committee is seeking a review of the District's Medicaid program, citing a "troubling" recent city audit of patient transport and reports of questionable billing.

In addition, the D.C. Office of the Inspector General is conducting two audits of the city's Medicaid transportation program -- one examining the background of providers and the other focusing on the legitimacy of claims being submitted by transport companies.

The federal and local scrutiny of the District's Medicaid transportation program follows a report last month in The Washington Times that noted long-standing lapses and concerns about the program.

Sens. Charles E. Grassley, Iowa Republican and chairman of the Senate Finance Committee, and Max Baucus of Montana, the panel's ranking Democrat, sent a letter Friday to D.C. Inspector General Charles Willoughby seeking a confidential briefing on efforts to probe city Medicaid costs.
The letter cites a recent report by Mr. Willoughby's office that found the city's Medicaid transportation program had "a serious breach of basic internal controls."

Mr. Grassley and Mr. Baucus said transportation costs "are often overlooked and represent a major opportunity for abuse."
The letter also expressed concern about reports of transportation providers billing services to patients who were dead when the claims were submitted.

The Times first reported that neither the D.C. Department of Health, which oversees Medicaid, nor the Washington Metropolitan Area Transit Commission, which licenses motor carriers, had conducted background checks of company officials in recent years.

A review of court records and other official documents of transportation companies on the D.C. Medicaid provider directory found company officials with criminal histories and others with numerous driving violations.

Last year, the District spent $22.3 million for nonemergency transportation of Medicaid patients -- slightly more than what the city paid for patients to see individual doctors, according to city records.

D.C. Council member David A. Catania, an at-large independent who has held hearings on the transportation problems, yesterday said that he's satisfied reforms are under way.

"I'm delighted we've taken the steps we've taken so that when this sit-down happens between our inspector general's office and the congressional representatives, they're going to be very impressed with some of the steps we've taken," said Mr. Catania, who has headed the council's health committee.

Medicaid, which provides health insurance for the poor, is funded by the federal government and the states, which also manage their programs.
An official with the D.C. Office of Inspector General yesterday said the office will meet with the Senate Finance Committee by the end of the month.
The Finance Committee letter requests updates on "all ongoing audits, evaluations and investigations that examine the Medicaid program in the District of Columbia."

The letter from Mr. Grassley and Mr. Baucus was similar to one the Finance Committee leaders also sent to the inspector general for the U.S. Department of Health and Human Services.

The federal government's watchdog on public health spending is conducting a nationwide review of Medicaid transportation costs.
According to its recently released 2007 audit plan, nonemergency transportation costs rose nationally by 48 percent from 1999 to 2003, reaching $1.5 billion.

What's more, the Washington-based Community Transportation Association of America says the District trailed only Alaska in how much it has paid for transporting Medicaid patients.

Alaska encompasses more than 581,000 square miles; the District, 63 square miles. Commercial airfares account for more than 90 percent of Alaska's Medicaid transportation costs, while the District relies on a fleet of private van carriers, according to records.

The District pays companies up to $140 per trip. By comparison, a cab ride across the city would cost about $40, plus tip.

The Senate committee letter says previous federal audits have found numerous shortcomings with nonemergency transportation, including "unnecessary trips and excessive claims as well as billing Medicaid for trips never provided."

D.C. officials say they are now conducting background checks of providers.

Mr. Catania said that Robert Maruca, deputy director of the Medical Assistance Administration, has done "extraordinary work" in outlining new measures, including steps to ensure all trips are medically necessary.

"Everyone was disappointed that the controls did not exist and that money was lost and stolen," Mr. Catania said. "But going forward, I think we'll see a dramatic reduction in the fraud and abuse in the program."