A'B'co.tvt4 Ri 13?.,4 1'1'15-ll DEPARTMENT OF AUDITS AND ACCOUNTS Medicaid and Local Government Audits AUDIT REPORT . FOR THE YEAR ENDED JUNE 30, 1996 B. R. RIDER TRANSPORTATION MEDICAID PROVIDER NUMBER 00568543A NON-EMERGENCY TRANSPORTATION PROGRAM TABLE OF CONTENTS LETTER OF TRANSMITTAL INTRODUCTION General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Audit.Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Scope and Methodology ................................................... 2 FINDINGS AND RECOMMENDATIONS Review of Paid Claims ..................................................... 5 Service Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Vehicle Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Number of Vehicles ....................................................... 8. PSC Requirements ........................................................ 9 Drivers' Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Business License Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Usual and Customary Charges .............................................. 11 Change of Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Report Prepared By: State ofGeorgia Department ofAudits and Accounts Medicaid and Local Govemment Audits Division 254 Washington Street, S. W., Suite 322 Atlanta, Georgia 30334-8400 (404) 656-2006 Michael A. Plant, Director CLAUDE L VICKERS STATE AUDITOR DEPARTMENT OF AUDITS AND ACCOUNTS 254 Washington Street, S.W., Suite 214 Atlanta, Georgia 30334-8400 Telephone (404) 656-2006 Facsimile (404) 656-7535 March 26, 1997 Members of the Board of Medical Assistance, and The Honorable Marge Smith, Commissioner Department ofMedical Assistance 2 Peachtree Street, N.W., 40th Floor Atlanta, Georgia 30303 Ladies and Gentlemen: This report provides the results of our audit ofB. R. Rider Transportation, provider number 00568543A, a participant in the Medicaid Non-Emergency Transportation Program for the period July 1, 1995 through June 30, 1996. This report is intended to be used solely in connection with the administration of the Georgia Department of Medical Assistance Non-Emergency Transportation Program and is not to be used or relied upon for any other purpose. Respectfully Submitted, CLV/by Claude L. Vickers State Auditor 1996 Audit Report: B. R. Rider Transportation 1 INTRODUCTION General Information The Georgia Medical Assistance Program (Medicaid) is administered by the Georgia Department of Medical Assistance (DMA) and is jointly funded by the State of Georgia and the federal government. Medicaid pays health care providers for furnishing health care services to individuals or families with low income and limited resources. The OMA has established specific payment guidelines and limitations for each covered medical service. Through the Non-Emergency Transportation (NET) program, the OMA provides reimbursement for Medicaid recipients' nonemergency transportation to obtain necessary medical services. Providers of these transportation services may enroll in the NET program as direct providers, and receive payments from the OMA based on their submitted claims for transportation services provided. Audit Objectives The purpose of this audit was to determine whether B. R. Rider Transportation, an enrolled provider in the Georgia Medicaid NET Program, maintained adequate documentation to support claims paid by the OMA for non-emergency transportation services provided from July 1, 1995 through June 30, 1996; and to determine whether B. R. Rider Transportation complied with the state and federal laws, regulations, policies, and procedures in effect for the NET Program 2 Scope and Methodology Non-Emergency Transportation Program during that period and at the time ofour audit. The specific objectives of this audit were to determine whether the provider: maintained sufficient documentation to support claims paid by theDMA; utilized correct service codes when billing the DMA for services; complied with Appendix G, "Minimum Vehicle Standards for Non-Emergency Transportation Program" contained in Policies and Proceduresfor Non-Emergency Transportation Sen,ices, published by the DMA; maintained all state required msurance coverage on its transportation vehicles; used the same vehicles as those registered with the DMA to transport recipients; complied with Georgia Public Service Commission (PSC) vehicle requirements for its transportation vehicles; complied with the DMA requirements for NET drivers; complied with applicable business license requirements; billed Medicaid its usual and customary charges for transportation services; and notified the DMA of any change in address due to a move or a change in ownership. To accomplish these objectives, we evaluated a sample of the provider's paid claims to determine if the provider complied with the 1996 Audit Report: B. R. Rider Transportation 3 provisions of Policies and Procedures for Non-Emergency Transportation Services, and to determine if the provider maintained sufficient documentary evidence to support claims filed by the provider and paid by the DMA. We also interviewed provider personnel, inspected vehicles used to transport Medicaid recipients, and examined other records and documents to determine if the provider complied with other provisions ofPolicies and Procedures for Non-Emergency Transportation Sen1ices. Our sample of 150 paid claims was randomly selected from a data file containing all of the provider's paid claims for the audit period. This data file was obtained from Electronic Data Systems (EDS) which processes all Medicaid claims for the Georgia NET Program. Our determination of the extent to which the provider maintained sufficient documentary evidence to support the payment of those claims in our sample was made by examining the provider's Medicaid Trip Sheet and Medical Certification for Non-Emergency Transportation (DMA 408) forms. The Department of Audits and Accounts is responsible for providing the DMA with information regarding the accuracy of claims paid to B. R. Rider Transportation during the period July 1, 1995 through June 30, 1996, and with information about the provider's compliance with other requirements of the DMA. If the DMA implements the recommendations in this report, or attempts to recover any amounts from the provider as a result of this report, the provider may appeal 4 Non-Emergency Transportation Program to the DMA for reconsideration ofthe audit findings. For this reason, we have not included a response from the provider in our report. However, we have discussed the contents of this report with the provider and have considered its responses when preparing the report. In all other respects, .this audit was conducted in accordance with generally accepted government auditing standards. 1996 Audit Report: B. R. Rider Transportation 5 FINDINGS AND RECOMMENDATIONS Review ofPaid aaims The DMA requires that non-emergency transportation providers maintain such records as are necessary to fully disclose the extent of services provided. These records must contain a completed Medicaid Trip Sheet (DMA 408 form) for each trip. Except for recipients receiving mental health, chemotherapy, radiation services, or dialysis, a signed Medical Certification for Non-Emergency Transportation (DMA 408 form) must also be obtained for each trip. B. R. Rider Transportation received payments totaling $211,766.51 for claims filed with a service date within the 1996 state fiscal year. A data file containing all of the provider's paid claims for that period was obtained from Electronic Data Systems (EDS). From this data file of4,257 paid claims, we randomly selected a sample of 150 claims totaling $7,629.08. For each claim in the sample, we attempted to locate and examine the provider's documentation (DMA 408 form) for that claim. As a result of this examination, we determined that $5,300.52 of the claims in the sample were insufficiently documented to support payment ofthe claims. The results of our examination of the sample, and the statistical projection of those results to the population of paid claims, is summarized in the following table. Based on these results, we conclude with 95% certainty that the total population of paid claims includes $130,983.00 in paid claims that are not sufficiently 6 Non-Emergency Transportation Program documented to support payment of those claims, and we recommend that the DMA seek to recover that amount from the provider. Sample Results and Projection to Population Number of Claims with Errors 104 Dollar Value ofErrors $5,300.52 Point Estimate $150,205.00 Lower Limit $130,983.00 Precision 12.80% The following is a list of the types of errors identified in the sample. In accordance with DMA instructions, any one of these errors causes the claim to be insufficiently documented. Each claim included in the amount of insufficiently documented claims in the above paragraph contained one or more of the following types of errors: No DMA 408 form was found to document the claim Date of transportation service did not match the medical certification date Odometer readings were missing or incomplete Number of miles billed exceeded the number of miles documented Mileage was unallowable or unreasonable for the claimed destination DMA 408 form contained an inappropriate signature DMA 408 form contained an incorrect revision date Incorrect NET service code was billed and paid 1996 Audit Report: B. R. Rider Transportation 7 Service Codes The DMA requires that providers use the appropriate code as outlined in Appendix D of Policies & Procedures for_ Non-Emergency Transportation Sen,ices when billing for services. Our audit included a review of the NET service code for each claim in the sample. We compared the service code paid for each claim to the provider's documentation in order to determine if the appropriate code was billed. The use ofincorrect service codes was found during the audit. These errors were included in the sample errors identified in the previous section and were also included in determining the total amount of insufficiently documented claims. Vehicle Standards As a condition of participation in the NET program, providers must comply with requirements specified in Appendix G of Policies and Proceduresfor Non-Emergency Transportation Services. Appendix G requires that all vehicles used by the provider to transport Medicaid recipients contain a basic first aid kit, a class B chemical type fire extinguisher with a gauge or annual inspection tag and mounted within the driver's reach, seat belts for all passengers, valid proof of vehicle insurance, and no hazardous debris or unsecured items. In addition to these requirements, vehicles used as wheelchair vans or nonemergency stretchers must also have some reasonable means of securing a wheelchair or stretcher, and vehicles used to transport infants or children must contain approved child seating. We inspected all of the provider's four current vehicles to determine 8 Non-Emergency Transportation Program whether the provider complied with the provisions of Appendix G. Based on our inspection, we determined that all vehicles were in compliance with DMA minimum vehicle standards. Insurance Col'erage As a condition of participation in the NET program, providers must maintain all state-required insurance coverage. The Georgia Public Service Commission requires minimum liability vehicle insurance coverage as follows: $100,000 bodily injury each person, $300,000 bodily injury each accident, and $50,000 property damage each accident. Our audit included a review of the provider's insurance coverage to determine whether required coverage was maintained from the beginning ofthe audit period through the date of our audit. Based on our review, we determined that the required insurance coverage was maintained for the entire period. Number of Vehicles The vehicle identification number (VIN) from each vehicle was compared to information furnished to us by EDS Provider Enrollment to determine whether the number ofvehicles operated by the provider and the VIN for each vehicle agreed with the DMA records. Based on this comparison, we determined that two vehicles registered with the DMA were no longer in service. The vehicles inspected during the audit included three wheelchair/stretcher vans, and one non- 1996 Audit Report: B. R. Rider Transportation 9 emergency stretcher. The EDS information indicates that the provider should have five wheelchair vans, and one non-emergency stretcher. PSC Requirements Policies andProceduresfor Non-Emergency Transportation Services requires that NET providers maintain current licenses, permits, or certifications as required by all levels of government in Georgia for operation of a vehicle. The State of Georgia requires that intrastate motor carriers apply to the Georgia Public Service Commission (PSC) for the issuance of a Vehicle Registration and Identification Stamp and a Vehicle Identification Cab Card (Form G). A current, original Form G, with registration and identification stamp affixed, must be maintained in each vehicle. As part of our audit, we determined whether each vehicle currently operated by the provider contained a valid PSC cab card. We found that all vehicles complied with the PSC requirements. Drivers' Requirements Policies and Proceduresfor Non-Emergency Transportation Services requires that each NET driver possess a valid Georgia driver's license, receive both a pre-employment health screening and a physical examination by a physician within six weeks of initial employment, and receive an annual health review if driving responsibilities account for 40% or more of that driver's work time. In addition, any driver who operates a wheelchair van or minibus that is designed to carry sixteen or more persons including the driver is required to possess a class C 10 Non-Emergency Transportation Program Business License Requirements driver's license. For any driver hired after August 1, 1988, the provider must document that a driving record was obtained for that driver prior to employment. Effective July 1, 1989, non-emergency stretcher attendants must have received training in cardiopulmonary resuscitation (CPR) or first aid. A list of the provider's NET drivers was prepared from information obtained during the audit. A total of eight NET drivers were identified from the beginning of the audit period through the date of the audit. For each driver identified, we determined whether the provider complied with the driver's requirements stated in the previous paragraph. As a result of our audit, we determined that all current NET drivers possess the required licenses, all have received the required physical examinations and annual health reviews, and the provider has documented that the driving records of all drivers were obtained prior to employment. All non-emergency stretcher attendants have received CPR or first aid training. As a condition of participation in the NET program, providers must maintain current licenses as required by all levels of government. Many local governments in Georgia require that businesses pay an annual fee in order to obtain a business license. As part of our audit, we determined whether the provider complied 1996 Audit Report: B. R Rider Transportation 11 with local business license requirements from the beginning of the audit period through the date of our audit. We examined all business licenses to determine if the provider was properly licensed during the periods reviewed. As a result of our audit, we determined that the provider complied with all business license requirements. Usual and Customary Charges Policies andProceduresfor Non-Emergency Transportation Services stipulate that a provider's submitted charges to the OMA must not exceed the provider's usual and customary charges to non-Medicaid passengers. As part of our audit, we reviewed the provider's transportation charges to determine whether Medicaid passengers were charged more than non-Medicaid passengers for the same services. Based on our review, we determined that the provider charged Medicaid recipients its usual and customary rates for non-emergency transportation services. Change ofAddress Instructions for completing the Provider Data Form for the Georgia Medical Assistance Program stipulate that if any of the information on the form changes, the provider should submit those changes to the Provider Enrollment Unit in writing. 12 Non-Emergency Transportation Program As part of our audit, we determined if the provider had a change of address due to a move or a change in ownership, and if so, whether the provider properly notified the DMA of this change. As a result of our audit, we determined that the provider has not had a change of address. The provider's current address is: B. R. Rider Transportation 1616 West Kellog Circle Douglasville, GA 30134-2069 The provider's NET records are maintained at 2860 Springfield Court, College Park, GA 30349.