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Ohio rolls out ways to curb medical transportation fraud

The state will start tracking ambulance VIN numbers to stop companies from shutting down to avoid paying back large audits, then reopening under a different name

By Josh Sweigart
Dayton Daily News

DAYTON, Ohio — State officials are unleashing a slew of new efforts targeted at cracking down on medical transportation fraud, which the Affordable Care Act identified as one of four major drivers of Medicaid fraud.

The other main areas of concern are home health care, durable medical equipment and waiver service programs such as adult day care.

One new effort will track vehicle identification numbers on ambulettes, according to officials with Ohio Medicaid, the auditor’s office and the attorney general’s office. The three work together to patrol Medicaid fraud.

The VINs are in play because of concerns that companies simply shut down instead of paying back large audits. They then could change ownership and re-open with the same vehicles under a different name.

Soon, companies using VINs from companies that got in trouble will face increased audits.

The VIN numbers are being collected in surveys sent out this month designed to better track ambulette companies across the state. The surveys will be used under a new contract with a company that conducts unannounced site visits to Medicaid providers.

That company, the Public Consulting Group, conducted 119 provider visits from November 2013 to February 2014 — 56 percent were visits to ambulette providers.

“Ohio Medicaid has introduced a series of reform measures aimed at tackling waste and abuse,” said Ohio Medicaid spokesman Sam Rossi.

Keesha Mitchell, head of the attorney general’s Medicaid Fraud Control Unit, said her office has added 35 new investigators to increase oversight of fraud as Medicaid expands.

She said one reason fraud is so prevelant in medical transportation is because there’s such a low bar to entry.

“If you have one ambulette and you have a provider number you can start billing the Medicaid program,” she said.

The MFCU has received 77 complaints about ambulette and ambulance companies since 2011. That has resulted in 17 convictions and $2.1 million in ordered recovery.

The MFCU’s annual report says it closed investigations of 25 ambulance and ambulette companies last year. Investigators stake out ambulette companies, watching to make sure riders are using wheelchairs. They also interview riders and employees.

In state fiscal year 2013, the MFCU convicted 135 people and companies for all kinds of Medicaid fraud, and completed 21 civil settlements. The total value of criminal restitution and civil settlements that year was $77.2 million.

The MFCU has a nearly $9 million budget.

Lloyd Early, head investigator for the fraud control unit, said the new site visits are weeding out bad providers and have resulted in several new criminal investigations.

“It’s proving to be an effective front door to the Ohio Medicaid program,” he said.

Ohio Chief Deputy Auditor Bob Hinkle said his office is working to increase the number of audits, and make them shorter to hit more providers every year.

“It may not be as high of intensity in that we’re looking at a number of transactions across years, but it’s so we can get in and get out, issue our findings, our results, and touch more providers,” he said. “We know that it has a deterrent effect. The more providers we touch the more the word gets out there, the less fraud we believe will occur.”