DEPARTMENT OF AUDITS AND ACCOUNTS Medicaid and Local Government Audits lrA Ai~C,,IY14 RI T3Sb MONITORING REPORT OF NON-EMERGENCY TRANSPORTATION VEHICLE INSPECTIONS AND PROVIDER INTERVIEWS TECHNO SYSTEMS, 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 of Vehicle Inspections .............................6 <.. 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 of Non-Emergency Transportation (NET) vehicles and interviews with service providers in the NET region operated by Techno Systems, 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. CLV/bw Respectfully Submitted, ~~ Claude L. Vickers State Auditor 1998 Report: Vehicle Inspections & Provider Interviews in Techno Systems NET Region 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 Techno Systems, Inc., was awarded a contract for the Fulton/Dekalb region. As the NET broker, Techno Systems, Inc., is responsible for arranging transportation in properly equipped vehicles for Medicaid recipients in its region. It is Techno Systems, Inc.'s, responsibility to ensure that service providers in its region 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). 2 Objectives Non-Emergency Transportation Program The purpose of this review was to determine whether the service providers in Techno Systems, Inc. 's, NET region have properly equipped vehicles for the transportation of Medicaid recipients, and to obtain an understanding ofthe working relationships between the service providers and Techno Systems, Inc. The specific objectives of this review were to determine whether: Techno Systems 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 Techno Systems; and any service provider had any specific unresolved problems with Techno Systems; Scope and Methodology To accomplish these objectives, we obtained a listing ofservice providers from Techno Systems, 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 Techno Systems, Inc., was abiding by its contract. 1998 Report: Vehicle Inspections & Provider Interviews in Techno Systems NET Region 3 FINDINGS AND RECOMMENDATIONS Vehicle Inspections We visited 40 transportation service providers and inspected 112 non-emergency vehicles used to transport Medicaid recipients in Techno Systems' region. 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 ofthe NET vehicles in Techno Systems' region and to determine whether Techno Systems was inspecting the vehicles as required by the RFP. Of the 112 vehicles that we inspected, only four met the requirements we checked, and many were not in compliance with several of the requirements outlined in the RFP. Appendix I and Appendix II of this report summarize our findings by payment type and by service provider. Techno Systems, Inc., had permission from the DMA to operate some of its own vehicles to transport Medicaid recipients. When we attempted to set up an appointment to inspect these vehicles, we were informed by the Transportation Coordinator for Techno Systems, Inc., that it had sold its vans to Adams Transportation. The owner of Adams Transportation called and told us that the vehicles were not in compliance with the vehicle requirements of the RFP and that they would not be ready for inspection for a few weeks. We gave Adams Transportation a couple of weeks before we inspected the vehicles. At the time of our inspection, none of the vehicles were in compliance with RFP requirements. Adams Transportation has since discontinued its working relationship with Techno Systems. We recommend that the DMA assess liquidated damages as set forth in the RFP. We also recommend that periodic reviews be conducted to ensure that Techno Systems, Inc., examines and removes from service those vehicles that do not comply with all vehicle standards contained in the RFP. 4 Non-Emergency Transportation Program Service Provider Interviews We talked with all 40 active service providers in Techno System's region. We asked ifthey were being paid according to the terms oftheir contracts with the Broker, what kinds ofproblems 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. 22 service providers complained of payment problems with Techno Systems. Payments have consistently been late according to 16 service providers. They stated that payments are received two to three weeks later than stated in their contracts. In addition, we were told that when service providers receive payments for less than the amounts billed, no explanations are given for the reductions. We were unable to verify late payments to service providers, but we did obtain evidence of reduced payments with no explanations. One service provider has begun legal action against Techno Systems, Inc., claiming that it is owed $26,023.21 for past due claims and prior discrepancies in claims paid. This service provider gave us a copy of a letter sent to Techno Systems from its lawyer and said that it had given a copy of the same letter to the OMA. Poor communications with the Broker was the complaint of 16 service providers. Ten told us they have trouble getting in touch with personnel at Techno Systems, and when they have been able to talk with someone, they have not received answers to their questions. Nine service providers complained about the scheduling of trips, and five claimed they are not receiving enough trips. They do not understand why Techno Systems is allowed to operate its own vehicles when many of the service providers are not receiving enough scheduled trips to stay in business. Four service providers specifically complained about inefficient scheduling by Techno Systems that resulted in assessed liquidated damages against them for "no shows". We recommend that the OMA further review the operations ofTechno Systems, Inc., to ensure that the it abides by all provisions of its contracts with its service providers. 1998 Report: Vehicle Inspections & Provider Interviews in Techno Systems NET Region 5 Overall Comments and Recommendations We found that Techno Systems, Inc., has not complied with many of the terms of its contract with the DMA. Techno Systems conducted only initial inspections ofits service providers' vehicles, many of which were not in compliance at that time, and has not followed up with any other inspections to ensure that all vehicles are in compliance. The vehicles that Techno Systems, Inc., owned and operated were not in the proper condition as set forth by the vehicle requirements in the RFP. In addition, we were also told by Adams Transportation that the drivers of the vehicles purchased from Techno Systems had received very little training. It also appears that Techno Systems has not paid many of its service providers according to the terms of their contracts. We recommend that the DMA assess liquidated damages as specified in the RFP. We also recommend that the DMA further review the operations ofTechno Systems, Inc., to ensure that it complies with the requirements ofNET program regulations. Appendix Information Attached to this report are summaries of our vehicle inspections. Appendix I lists the standards we reviewed for compliance and the number of vehicles not in compliance with each standard. Appendix II lists the number of vehicles we inspected and the number we found in compliance for each service provider. 6 Non-Emergency Transportation Program Appendix/ SUMMARY OF VEHICLE INSPECTIONS 112 vehicles were inspected. 4 vehicles met all standards. 7 vehicles did not contain an operable two-way communications system. 9 vehicles contained inadequate heating and air conditioning. 81 vehicles did not contain two (2) seat belt extensions. 44 vehicles contained no seat belt cutter mounted above the driver's door. 6 vehicles contained no functioning interior light. 1 vehicles did not have an exterior rear view mirror on each side of the vehicle. 2 vehicles did not have adequate side wall padding and ceiling covering in the vehicle. 10 vehicles did not contain an interior rear view mirror. 4 vehicles contained hazardous debris or unsecured items. 47 vehicles did not contain the provider's name, the vehicle number, and the Broker's telephone number prominently displayed inside the vehicle. 86 vehicles did not contain a functional fire extinguisher of at least 5 pounds mounted within reach of the driver. 27 vehicles did not contain a retractable ste_p or a step stool for passenger use. 60 vehicles did not contain three (3) portable triangular reflectors mounted on stands. 19 vehicles did not contain a vehicle information packet with vehicle registration, valid proof of insurance, and accident procedures and forms. 1998 Report: Vehicle Inspections & Provider Interviews in Techno Systems NET Region 7 27 vehicles contained no valid PSC cab card. 23 vehicles contained no fully equip_ped first aid kit. 48 vehicles contained no spill kit. 41 vehicles contained no map of the NET region. 8 Non-Emergency Transportation Program Aopendixll VEHICLE INSPECTIONS BY SERVICE PROVIDER , .{ Provider Name A Loving Touch Adams Transportation Advance Medical Receivables AJCC Weinstein Center Allen N.E.T. Service, Inc. American Medical Response Blackbum Transportation Cameron Transportation Common Health Transportation Dial-A-Ride Transportation Divine Order Dudley Transportation Five Star N.E.T. Gatlin Transportation Global Transportation Howard & Smith It's About Time N.E.T., Inc. J's Transportation J.D. Transportation J.S. N.E.T., Inc. L&J Transportation Lord & Myers, Inc. Loving Hart's Transportation Medstat E.M.S., Inc. Olga Transportation On-Time Transportation Outreach Transportation P&B Transport # of Vehicles Inspected # of Vehicles Meeting all Requirements We Checked 3 0 19 0 0 NIA (out of business at time of our visit)) 4 0 3 0 0 NIA (emergency ambulance vehicles only) 2 0 1 0 1 0 2 0 3 0 2 0 3 0 2 0 3 0 3 0 1 0 5 0 2 0 2 0 2 0 3 0 1 0 4 2 1 0 2 2 1 0 4 0 1998 Report: Vehicle Inspections & Provider Interviews in Techno Systems NET Region 9 Patrona's Transportation Puckett Transportation Rogers Transportation S&B Transport Senior Connection of Dekalb Special Touch, Inc. Star Plus Transportation Styles Transportation T&TN.E.T. Tyler Transportation Universal Travel Vinson Transportation Totals 1 0 1 0 2 0 2 0 6 0 5 0 1 0 2 0 6 0 3 0 2 0 2 0 112 4 3.6% Met Requirements We Checked.