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Minnesota Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Program

Federal regulations require each State to ensure that Medicaid beneficiaries have necessary transportation to and from medical providers. During the period October 1, 2012, through September 30, 2013, the Minnesota Department of Human Services (State agency) claimed at least $6.4 million for payments to nonemergency medical transportation (NEMT) providers. Prior OIG reviews have found that States' claims for NEMT services were not always in accordance with Federal and State requirements.

Our objective was to determine whether the State agency claimed Federal Medicaid reimbursement for NEMT service claims submitted by transportation providers in Minnesota in accordance with certain Federal and State requirements.

We obtained from the State agency claim information it used to reimburse transportation providers under the NEMT program. We obtained and reviewed documentation from transportation providers to determine whether their claims met certain Federal and State requirements.

The State agency claimed Federal Medicaid reimbursement for some NEMT claims submitted by transportation providers that did not comply with certain Federal and State requirements. Of the 104 reviewed NEMT lines of service in our stratified random sample, the State agency properly claimed Medicaid reimbursement for 25 lines of service. However, the remaining 79 lines of service did not comply with Federal and State regulations.

The claims for unallowable services were made because the State agency's policies and procedures for overseeing the Medicaid program did not ensure that providers complied with Federal and State requirements for documenting and claiming NEMT services.

We recommended that the State agency (1) refund $1,871,457 to the Federal Government and (2) strengthen its policies and procedures to ensure that providers (a) document all services in accordance with Federal and State requirements and (b) provide transportation services only to beneficiaries receiving Medicaid-covered services.

In written comments on our draft report, the State agency agreed with our recommendations and mostly agreed with our findings. The State agency noted that most transportation documentation deficiencies were the result of conflicting instructions in place during the time of our audit or technical difficulties. The State agency noted that instructions have been clarified and that it would work with providers to better document the transportation services.

Filed under: Centers for Medicare and Medicaid Services