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Review of Medicaid Payments for Nonemergency Medical Transportation Services Claims Submitted by Providers in New York State

We found that the Department of Health (DOH) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services submitted by transportation providers in New York State that did not comply with certain Federal and State requirements. States are required to ensure necessary transportation for Medicaid beneficiaries to and from providers. Based on our sample results, we estimate that DOH improperly claimed $13.5 million in Federal Medicaid reimbursement for 723,237 NEMT claims during the period April 1, 2005, through March 31, 2006.

Of the 100 NEMT claims in our random sample, DOH properly claimed Medicaid reimbursement for 57 claims. However, for the 43 remaining claims, DOH claimed Medicaid reimbursement for services that were not allowable or were potentially unallowable. Specifically, 40 claims contained services that did not comply with certain Federal and State requirements, and for 3 claims, we could not determine whether services complied with Federal and State regulations. Of the 40 noncompliant claims, 11 contained more than 1 deficiency.

We recommended that DOH (1) refund $13.5 million to the Federal Government; (2) strengthen its policies and procedures to ensure that providers comply with Federal and State requirements for ordering, documenting, and claiming NEMT services; and (3) require the New York State social services districts to strengthen their quality assurance mechanism to ensure that NEMT services are properly provided. DOH partially agreed with our first recommendation (financial disallowance) and agreed with our remaining recommendations.

Filed under: Centers for Medicare and Medicaid Services