Audit report, Non-Emergency Transportation Program, Richmond Ambulance Service, Inc., Augusta, Georgia, Medicaid provider no. 00185083A for the year ended June 30, 1995

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AUDIT REPORT NON-EMERGENCY TRANSPORTATION PROGRAM
RICHMOND AMBULANCE SERVICE, INC. AUGUSTA, GEORGIA
MEDICAID PROVIDER NUMBER 00185083A FOR THE YEAR ENDED JUNE 30, 1995
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

TABLE OF CONTENTS
LETTER OF TRANSMITTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
AUDIT OBJECTIVES, SCOPE AND METHODOLOGY . . . . . . . 1
FINDINGS AND CONCLUSIONS
Sample Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Procedure Codes ......................................................... 3 Vehicle Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... 3 Business License Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... 4 Usual and Customary Charges ............................................... 4 Change of Address ........................................................ 5

L. CLAUDE VICKERS
STATE AUDITOR
(404) 656-2174

DEPARTMENT OF AUDITS AND ACCOUNTS
254 Washington Street, S.W., Suite 214 Atlanta, Georgia 30334-8400
November 7, 1996

Members of the Board of Medical Assistance, and The Honorable Marge Smith, Commissioner Department ofMedical Assistance 2 Peachtree Street, N.W., Suite 27-100 Atlanta, Georgia 30303
Ladies and Gentlemen:
This report provides the results of our audit ofRichmon~ Ambulance Service, Inc., provider number 00185083A, a participant in the Medicaid Non-Emergency Transportation Program for the period July I, 1994, through June 30, 1995. This audit was conducted in accordance with the terms ofthe December I, 1994, agreement between the Georgia Department ofMedical Assistance and the Georgia Department of Audits and Accounts.
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.

CLV/by

Respectfully Submitted,
~~
Claude L. Vickers
State Auditor

1995 Audit Report: Richmond Ambulance Service, Inc.

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AUDIT OBJECTIVES, SCOPE, AND METHODOLOGY
The purpose of this audit was to determine whether Richmond Ambulance Service, Inc., an enrolled provider in the Georgia Medicaid Non-Emergency Transportation (NET) Program, maintained adequate documentation to support claims paid by the Georgia Department of Medical Assistance (DMA) for non-emergency transportation services from July 1, 1994 through June 30, 1995; and to determine whether Richmond Ambulance Service, Inc., complied with the DMA policies and procedures for the NET Program in effect during that period. The specific objectives ofthis audit were to determine if the NET provider:
maintained sufficient documentation to adequately support claims paid by the DMA; utilized correct procedure codes when billing the DMA for services; complied with Appendix G, "Minimum Vehicle Standards for. Non-Emergency
Transportation Program" contained in the Policies and Procedures for Non-Emergency Transportation Services;
maintained all state required insurance coverage on transportation vehicles; used the same number ofvehicles to transport recipients as the number of vehicles registered
with the DMA; complied with Public Service Commission requirements for vehicles used to transport
recipients; complied with applicable requirements for NET drivers; complied with applicable business license requirements; billed Medicaid its usual and customary charges; and notified the DMA of changes in address due to a move or a change in ownership.
To accomplish these objectives, we developed a statistically valid attribute sampling plan to
test a sample of the provider's Medicaid Trip Sheet andMedical Certification for Non-Emergency Transportation (DMA 408) forms to determine if the DMA 408 forms provided 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 documentation in order to determine if the provider complied with provisions of the DMA Policies and Procedures Manual.

1995 Audit Report: Richmond Ambulance Service, Inc.

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FINDINGS AND CONCLUSIONS
SAMPLE RESULTS
The OMA 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 OMA 408 form for each trip. Except for recipients receiving mental health, chemotherapy, radiation services, or dialysis, a signed medical certification must also be obtained for each trip.
A data file containing all ofthe provider's paid claims for the audit period was obtained from EDS. Based on the total number of records in this data file, a statistically valid sample size was computed, and a corresponding number of paid claims were randomly selected ~s our sample. For each claim listed in the sample, we attempted to locate and examine the provider's documentation (OMA 408 form) for that claim.
The provider received payments totaling $110,478.50 for claims filed with a service date within the 1995 state fiscal year. The statistically valid sample ofOMA 408 forms represented claims of $22,261.50, or 20.15% ofdollars paid. As a result ofthis audit, it was determined that $3,214.00 of the claims included in the sample were not sufficiently documented to support payment of the claims. Based on these results, we conclude with 95% certainty that the total population of paid claims includes $13,133.00 in paid claims that are not sufficiently documented to support payment of the claims, and we recommend that the OMA seek to recover that amount from the provider.
The following is a list ofthe types oferrors identified in the sample. In accordance with OMA instructions, any one of these errors causes the claim to be insufficiently documented. Each claim included in the amount ofinsufficiently documented claims in the above paragraph contained one or more ofthe following types of errors:
No OMA 408 form was provided to document the service Date of transportation service did not match medical certification date Recipient's Medicaid number was missing Recipient's Medicaid number did not match claim data

1995 Audit Report: Richmond Ambulance Service, Inc.

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Odometer readings were missing Number of miles billed exceeded the number of miles documented Reason for non-emergency stretcher was missing Reason for medical transportation was missing or unallowable DMA 408 form was signed by an inappropriate person

PROCEDURE CODES
DMA policies and procedures specify that providers must use the appropriate code as outlined in Appendix D of the DMA Policies & Procedures Manual when billing for services.
Our audit included a review of the NET procedure code associated with each claim in the sample. We compared the procedure code billed for each claim to the provider's documentation in order to determine ifthe appropriate code was used. The use of incorrect procedure codes was not noted during the audit.

VEHICLE STANDARDS
Richmond Ambulance Service, Inc., operates only emergency ambulance vehicles licensed by the Georgi.a Department ofHuman Resources. Therefore, it is exempt from the vehicle and driver's requirements specified in Appendix G of Policies and Procedures for Non-Emergency Transportation Services.

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

1995 Audit Report: Richmond Ambulance Service, Inc.

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accident, and $50,000 property damage each accident. Our audit included a review of the provider's insurance coverage to 4etermine whether
required coverage was maintained from the beginning of the audit period through the date of our audit. Based on our review, we detennined that the required insurance coverage was maintained for the entire period.

BUSINESS LICENSE REQUIREMENTS As a condition ofparticipation in the NET program, providers must maintain current licenses
as required by all levels ofgovernment. Many local governments in Georgia require that businesses pay an annual fee in order to obtain a business license.
As part ofour audit, we detennined whether the provider complied with local business license requirements during the period under audit and through the date of this audit report. We examined all business licenses to determine ifthe provider was properly licensed during the periods reviewed, and to determine ifthe business address agreed with the provider's address on file with the DMA.
As a result of our audit, we determined that the provider complied with all business license requirements, and that the providers business address as listed on the current business license agrees with the address on file with the DMA.

USUAL AND CUSTOMARY CHARGES DMA Policies and Procedures stipulate that a provider's submitted charges to the DMA must
not exceed the provider's usual and customary chargeto private paying passengers. As part ofour audit, we reviewed the provider's transportation charges for both Medicaid and
non-Medicaid patients in order to determine whether Medicaid patients were charged more than other patients for the same services.
Based on our review, we determined that no private-pay passengers were transported during the audit period.

1995 Audit Report: Richmond Ambulance Service, Inc.

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CHANGE OFADDRESS
Instructions for completing the Provider Data Form for the Georgia Medical Assistance Program stipulate that ifany ofthe information on the form changes, the provider should submit those changes to the Provider Enrollment Unit in writing.
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: Richmond Ambulance Service, Inc. 2035 Central Avenue Augusta, Georgia 30914