Audit report, for the year ended June 30, 1996, Booker Transportation Service, Medicaid provider no. 00595042A, Non-Emergency Transportation Program

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BS8 DEPARTMENT OF AUDITS AND ACCOUNTS tcil/5 -"l6 Medicaid and Local Government Audits
AUDIT REPORT FOR THE YEAR ENDED JUNE 30, 1996 BOOKER TRANSPORTATION SERVICE
MEDICAID PROVIDER NUMBER 00595042A 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 ofVehicles ......................................................... 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 Government 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

October 7, 1997

Members of the Board of Medical Assistance, and The Honorable Dr. William R. Taylor, Acting Commissioner Department of Medical Assistance 2 Peachtree Street, N.W., 40th Floor Atlanta, Georgia 30303
Ladies and Gentlemen:
This report provides the results of our audit of Booker Transportation Service, provider number 00595042A, 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/bw

Claude L. Vickers State Auditor

1996 Audit Report: Booker Transportation Service

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 DMA has established specific payment guidelines and limitations for each covered medical service.
Through the Non-Emergency Transportation (NET) program, the DMA 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 DMA based on their submitted claims for transportation services provided.

Audit Objectives

The purpose of this audit was to determine whether Booker Transportation Service, an enrolled provider in the Georgia Medicaid NET Program, maintained adequate documentation to support claims paid by the DMA for non-emergency transportation services provided from July 1, 1995 through June 30, 1996; and to determine whether Booker Transportation Service complied with the state and federal laws, regulations, policies, and procedures in effect for the NET

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Scope and Methodology

Non-Emergency Transportation Program
Program during that period and at the time of our audit. The specific objectives ofthis audit were to determine whether the provider:
maintained sufficient documentation to support claims paid by the OMA;
utilized correct service codes when billing the OMA for services;
complied with Appendix G, "Minimum Vehicle Standards for Non-Emergency Transportation Program" contained in Policies and Procedures for Non-Emergency Transportation Services, published by the OMA;
maintained all state required insurance 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 li~ense 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: Booker Transportation Service

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prov1s1ons 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 perso~el, inspected vehicles used to transport Medicaid recipients, and examined other records and documents to determine if the provider complied with other provisions of Policies and Procedures for Non-Emergency Transportation Services.
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 Booker Transportation Service 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

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Non-Emergency Transportation Program

to the OMA 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: Booker Transportation Service

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FINDINGS AND RECOMMENDATIONS

Review ofPaid Claims

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.
Booker Transportation Service received payments totaling $118,127.95 for claims filed with a service date within the 1996 state fiscal year. A data file containing all ofthe provider's paid claims for that period was obtained from Electronic Data Systems (EDS). From this data file of 5,792 paid claims, we randomly selected a sample of 150 claims totaling $3,041.80. 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 all of the claims in the sample were insufficiently documented to support payment of the 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

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Non-Emergency Transportation Program

includes $116,705.00 in paid claims that are not sufficiently 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 ofClaims with Errors

150

Dollar Value ofErrors

$3,041.80

Point Estimate

$118,373.00

Lower Limit

$116,705.00

Precision

1.41%

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 Medical Certification date was missing 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

1996 Audit Report: Booker Transportation Service

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Reason for medical transportation was m1ssmg or unallowable
Type of transportation was missing, unallowable, or not medically certified
DMA 408 form was not signed DMA 408 form contained an incorrect revision date

Service Codes

The DMA requires that providers use the appropriate code as outlined in Appendix D of Policies & Procedures for Non-Emergency Transportation Services 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 of incorrect service codes was not found during the audit.

Vehicle Standards

As a condition of participation in the NET program, providers must comply with requirements specified in Appendix G of Policies and Procedures for 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

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Non-Emergency Transportation Program

addition to these requirements, vehicles used as wheelchair vans or non-emergency 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 the provider's one current vehicle to determine whether the provider complied with the provisions of Appendix .G. Based on our inspection, we determined that the vehicle contained a fire extinguisher which was not mounted within reach of the driver.

Insurance Coverage

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 of the 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

1996 Audit Report: Booker Transportation Service

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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 one vehicle registered with the DMA was no longer in service. The vehicle inspected during the audit was a minibus. The EDS information indicates that the provider should have two minibuses.

PSC Requirements

Policies and Proceduresfor 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 the provider's vehicle 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,

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Non-Emergency Transportation Program

and receive an annual health review ifdriving 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 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 wa~ prepared from information obtained during the audit. One NET driver was identified from the beginning of the audit period through the date of the audit. For that driver, 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 the driver possessed the required license, had received the required physical examination, and the provider had documented that the driving record had been obtained prior to employment. However, the driver had not received the required annual health review.

Business License Requirements

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.

1996 Audit Report: Booker Transportation Service

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As part of our audit, we determined whether the provider complied 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 and Proceduresfor Non-Emergency Transportation Services stipulate that a provider's submitted charges to the DMA 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 no non-Medicaid passengers were transported during the audit period.

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.

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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 had a change of address and did not properly notify the DMA of the change. The provider's current address is: Booker Transportation Service 4524 Brier's Court Stone Mountain, Georgia 30083