Monitoring report of Non-Emergency Transportation vehicle inspections and provider interviews, Logisticare, Inc. [1998]

DEPARTMENT OF AUDITS AND ACCOUNTS Medicaid and Local Government Audits
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MONITORING REPORT OF NON-EMERGENCY TRANSPORTATION VEHICLE INSPECTIONS AND PROVIDER INTERVIEWS
LOGISTICARE, INC.

TABLE OF CONTENTS
LETTER OF TRANSMITTAL . ............................. I
INTRODUCTION .......................................... 1 General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Broker Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 1 Objectives ............................................. 2 Scope and Methodology .................................. 2
FINDINGS AND RECOMMENDATIONS .................... 3
APPENDIX I Summary ofVehicle Inspections ........................... 7
APPENDIX II Vehicle Inspections by Service Provider ..................... 8

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
(404) 656-2174

DEPARTMENT OF AUDITS AND ACCOUNTS
254 Washington Street, S.W., Suite 214 Atlanta, Georgia 30334-8400

November 25, 1998
Dr. William R. Taylor, Commissioner Georgia Department of Medical Assistance 2 Peachtree Street, N.W. Atlanta, Georgia 30303-3159
Dear Dr. Taylor:
This report provides the results of our inspections ofNon-Emergency Transportation (NET) vehicles and interviews with service providers in the three NET regions operated by LogistiCare, Inc. These inspections and interviews were conducted at your request.
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

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 1

INTRODUCTION

General Information

The Medicaid program in Georgia 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 to furnish health care services to individuals or families with low income and limited resources. The DMA has established specific guidelines and limitations for each covered medical service.

Effective October 1, 1997, the DMA established five geographical regions for the administration of the Non-Emergency Transportation (NET) program. The DMA solicited bids from potential brokers for the administration and provision of NET services in each region, and awarded contracts based on an evaluation of the received bids. All bids were in response to a Request for Proposal (RFP) which outlined all specifications required to become a Broker in the State of Georgia. The DMA selected three Brokers to cover the five geographical regions, and using the bid received from each Broker, and incorporating the RFP specifications, entered into a contract for the provision of NET services.

Broker Information

LogistiCare, Inc., was awarded contracts for the Central, East, and Southwest regions. As the NET broker, LogistiCare, Inc., is responsible for arranging transportation in properly equipped vehicles for Medicaid recipients in each of its three regions. It is LogistiCare, Inc.' s, responsibility to ensure that all providers in its three regions are operating vehicles used to transport Medicaid recipients in accordance with vehicle requirements established by the DMA (RFP sections 3.011, 3.240, and 3.241).

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 2

Objectives

The purpose of this review was to determine whether the service providers in LogistiCare, Inc. 's, three NET regions have properly equipped vehicles for the transportation of Medicaid recipients, and to obtain an understanding of the working relationships between the service providers and LogistiCare, Inc.
The specific objectives of this review were to determine whether:
LogistiCare is ensuring that all vehicles used by its service providers to transport Medicaid recipients meet the standards established by the DMA;
all service providers are receiving payments according to their contracts with LogistiCare, and
any service provider had any specific unresolved problems with LogistiCare.

Scope and Methodology

To accomplish these objectives, we obtained a listing of service providers from LogistiCare, Inc. We visited each service provider and inspected its NET vehicles to determine if the vehicles complied with certain vehicle standards set by the DMA. We also interviewed each service provider and asked whether LogistiCare, Inc., was abiding by its contract with the service provider. Finally, we asked LogistiCare, Inc., for its response to comments made by the service providers.

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 3
FINDINGS AND RECOMMENDATIONS
Vehicle Inspections
We visited 75 transportation service providers and inspected 608 non-emergency vehicles used to transport Medicaid recipients in LogistiCare's three regions. We did not check for compliance with every vehicle requirement listed or referenced in the RFP. Our goals were to determine the general physical condition of the NET vehicles in LogistiCare's regions and to determine whether LogistiCare was inspecting the vehicles as required by the RFP.
Of the 608 vehicles that we inspected, 362 were operated by service providers paid capitated rates, 240 were operated by service providers paid fee-for-service rates, and 6 were operated by a service provider paid a combination of both rates. We found that only 85% of the vehicles of capitated providers met all the requirements we checked and only 52% of fee-for-service providers' vehicles met those same requirements. Five of the six vehicles operated by the provider receiving a combination of both rates met all the requirements we checked. Appendix I and Appendix II of this report summarize our :findings by payment type and by service provider.
When LogistiCare learned that we were conducting vehicle inspections, it began inspecting service providers' vehicles. In fact, while in the field, our auditors met one ofLogistiCare's field representatives who was also inspecting vehicles. According to a checklist that the field representative showed to our auditors, LogistiCare is conducting very comprehensive inspections ofprovider vehicles. In addition, we have recently heard that LogistiCare removed vehicles from service because they failed to comply with all vehicle standards of the RFP.
We recommend that periodic reviews be conducted to ensure that LogistiCare continues to examine and remove from service those vehicles that do not comply with all vehicle standards contained in the RFP.

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 4
Service Provider Interviews
We talked with all 75 active service providers in LogistiCare, Inc.'s, three regions. We asked them if they were being paid in accordance with their contracts with LogistiCare, what kinds of problems they had experienced since the broker system began, whether those problems had been resolved, and if they had any suggestions for improving the NET program.
We were told by 12 fee-for-service providers that LogistiCare, Inc., consistently reduces the mileage billed and therefore, the amounts paid. For example, if a recipient's address and the destination address are in the same city, LogistiCare only allows 10 miles, regardless of how many miles it may actually be between the two destinations. We did not verify any of the mileage ourselves, but we did see documentation that LogistiCare changed trips from higher mileage categories to lower mileage categories, thereby reducing the payments to service providers. According to LogistiCare, it contracted with a company in Florida to determine all trip mileage. The first time a new route is used, that mileage is logged into the system for future reference. Ifa dispute arises with the service provider, LogistiCare sends a field representative out to actually drive the route. Ifthe provider's claim is justified, LogistiCare manually inserts the correct mileage and pays the original amount billed.
The most common complaint we heard, from 24 service providers, was poor communication with the Broker. The complaints ranged from not being able to get in touch with a person at LogistiCare when there is a problem to never receiving a call back after leaving messages on the Broker's voice mail. One service provider complained about receiving trips for deceased recipients after repeatedly telling LogistiCare that the recipients were dead. One reason that many calls may have gone unanswered is that providers were all directed to one person at LogistiCare and she could not handle the capacity. According to LogistiCare, it has recently hired three additional people to handle complaints. We have not talked with any of the service providers since the additional personnel have been hired to determine if communication has improved.
Seven service providers expressed concern that LogistiCare had changed the terms of their contracts with little or no advanced notice. However, all documents that we obtained from the service providers showed that they were given written notice from the Broker in accordance with the terms of their contracts.
The scheduling of trips was another type of complaint that we heard about the Broker. One provider claimed that LogistiCare sometimes scheduled trips over 100 miles away to transport a

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 5
recipient less than 20 miles. Two service providers said they are receiving trips for recipients who are traveling to facilities that are far away when the same treatment could be done at a much closer facility. We were told that in one instance two recipients living in the same household were transported by two different service providers, and that LogistiCare has sometimes scheduled two providers to pick up the same recipient and then paid only one of them.
We did not specifically verify this information, but we did ask LogistiCare about the problems, and they acknowledged that some scheduling problems do still exist. According to LogistiCare, it must sometimes ask providers to travel further than normal to transport a recipient. The service provider has the right to cancel a trip without any repercussions, and LogistiCare will try to find another service provider to make the trip. In regards to two different service providers scheduled to transport the same recipient, LogistiCare stated this only occurs when one service provider cancels a trip, it is reassigned to another service provider, and then the original service provider decides to make the trip. Then both service providers show up to transport the recipient, but only the second service provider will be paid because the original trip has been canceled in the computer. The Broker did state that this was a problem in the beginning because service providers were trying to steal recipients from other service providers. However, when they did not get paid for trips that were not assigned to them, the problem essentially disappeared.
We recommend that periodic reviews be conducted to ensure that the Broker continues to abide by all contracts with its service providers and the DMA.
Overall Comments and Recommendations
We found that LogistiCare, Inc., now appears to be complying with the terms of its contract with the DMA as it relates to vehicle standards and meeting the terms of its contracts with its service providers. It has recently begun conducting detailed inspections of vehicles and has removed from service vehicles that do not meet all standards. According to information we have obtained, LogistiCare pays its service providers according to their contracts. The Corporate Controller for LogistiCare, Inc., told us that it will soon have a software program in operation that will list each

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 6
claim paid and each claim denied, with denied claims having a code to inform service providers why they were denied. When implemented, these changes should reduce the number of complaints from service providers in LogistiCare's three NET regions.
We recommend that the DMA periodically review the operations ofLogistiCare, Inc., to ensure that it complies with the regulations of the NET program, and to verify that the changes promised by LogistiCare are actually made.
Appendix Information
Attached to this report are summaries of our service provider vehicle inspections. Appendix I liststhe items we reviewed for compliance with the vehicle standards and the number of vehicles not in compliance with each standard. Appendix II shows a breakdown of service providers according to payment terms, either capitated or fee-for-service, and lists the number of vehicles we inspected and found in compliance for each provider.

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 7
Appendix I
SUMMARY OF VEHICLE INSPECTIONS 608 vehicles were inspected. 37 vehicles contained no maps of the NET region. 63 vehicles contained fire extinguishers which were not mounted within reach of the drivers. __!_vehicle contained no seat belts for all passengers.
6 vehicles used to transport children contained no ap_proved child seating. 4 vehicles contained hazardous debris or unsecured items. 6 vehicles contained no reasonable means for securing wheelchairs or stretchers. 30 vehicles contained no proof of valid vehicle insurance or no proof ofregistration.. 32 vehicles contained no valid PSC cab cards. 6 vehicles contained no two-way communication system. 27 vehicles contained no seat belt cutters mounted above the driver's door. 59 vehicles did not contain seat belt extensions (2). 24 vehicles did not contain portable triangular reflectors (3) mounted on stands. 24 vehicles did not contain accident procedures and forms. 16 vehicles contained no spill kits. 3 vehicles contained no fully equip_ped first aid kits.

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 8

Appendix/I

VEHICLE INSPECTIONS BY SERVICE PROVIDER

Capitated Providers .,
Provider Name

# of Vehicles # of Meeting all Vehicles Requirements Insuected We Checked

Adams Transport, Inc. All Atlanta Transportation Burke County Trans Sys Clark's Professional Care Transport Coachline, Inc. Gateway Community Service Board Golden Personal Care Golden Years Transportation Health Star Amb Corp Kay's Transport MED Tran N.E.W. Services, Inc. Medline, Inc. Middle Flint Community Ser Board Mids, Inc. NE Transportation, Inc. Pineland MH\MR\SA CSB Sure Way Medical Transportation Svc. Universal Transportation, Inc. Ward's Delivery Service We Care Too Transport

10

9

3

3

8

6

8

7

4

3

60

54

4

3

11

11

4

0

31

27

4

0

20

18

11

10

30

30

66

52

11

8

5

5

15

15

23

19

34

28

Totals

362

308

85% Met all Requirements we

checked.

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 9

Fee-fpr-service Providers
Provider Name

# of Vehicles # of Meeting all Vehicles Requirements Inspected We Checked

A & L Med-Travel, Inc.*

8

6

A-1 Medical Transporters, Inc.

6

6

Action Medical Transport

3

2

American Liberty EMS, Inc.

3

1

Archtrans

11

10

Augusta Cab

30

18

B & K Transport

6

0

B.R. Rider Transportation

2

2

CARE Transportation

7

7

Colquitt Regional Community Care

4

3

Concerted Services, Inc.

2

0

Dallas & Fitch Transportation

4

2

Georgia Transit Services, Inc.

2

0

Gold Cross Amb Svc, Inc.

5

4

Golden Isles Transport, Inc.

5

4

Hancock County Transit System

3

3

Health Allied Transit

3

0

Heartland EMS, Inc.*

0

n/a

(All Net Vehicles were Emergency

Ambulances)

Henry Transit

8

0

Hope Non-Emergency Transportation

5

0

Jefferson County Transit

5

3

Liberty Convalescence

3

0

Life Star Response of Ga.*

0

n/a

(All Net Vehicles were Emergency

Ambulances)

(

Lifeline Ambulance Svc.

0

n/a

(All Net Vehicles were Emergency

Ambulances)

Manor Transportation, Inc.

6

4

MED NET Systems, Inc.

3

0

Med Stat EMS

0

n/a

(All Net Vehicles were Emergency

Ambulances)

Med Tech EMS, Inc.

1

0

Med-Travel, Inc.

3

3

Medecon

10

8

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 10

Provider Name

# of Vehicles #of Meeting all Vehicles Requirements Inspected we checked

Medical Center of Central Ga

0

n/a

(All Net Vehicles were Emergency

Ambulances)

Medical Riders of Coastal Ga., Inc.

3

1

Medstar Ambulance Services
:,

0

n/a

(All Net Vehicles were Emergency

Ambulances)

Mid Ga Ambulance Service, Inc.

1

0

MTS, Inc. Older American Council of Middle Ga Peach Commuting Service People Movers, Inc. Pierce Transit System Professional Medical Transit Queens Limo and Van Svc, Inc. Rural / Metro Ambulance Shed's Way Transit Son Shine Transport Southeastern Med Life Talbot County Transit Taylor Transportation Tidelands Community Service Board Troup County EMS
Upson Regional Medical Center
Vital Care EMS
Waco Med Travel Warren County EMS We Care Transport

3

3

12

12

3

3

1

1

4

0

4

4

2

0

15

0

5

3

3

2

2

4

0

4

1

12

5

0

n/a

(All Net Vehicles were Emergency

Ambulances)

0

n/a

(All Net Vehicles were Emergency

Ambulances)

0

n/a

(All Net Vehicles were Emergency

Ambulances)

6

2

2

0

6

0

Totals

240

124

52% Met all Requirements we

checked.

*Provider bas stopped doing business with LogistiCare, Inc., since our visit.

1998 Report: Vehicle Inspections & Provider Interviews in LogistiCare's NET Regions 11

Capitation and Fee-for-Service

Provider Name AAA Medical Transport

# of # of Vehicles Vehicles in Total
Inspected Compliance

6

5

83% Met all Requirements we

checked.

Totals for All Providers

608

437 72% Met all Requirements we

checked.