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

During the period April 1, 2013, through March 31, 2014, the Louisiana Department of Health and Hospitals (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services claims submitted by transportation providers that did not comply with certain Federal and State requirements. Of the 120 NEMT claims in our sample, the State agency properly claimed Medicaid reimbursement for 83 claims. However, the remaining 37 claims contained services that did not comply with certain Federal and State regulations. Of the 37 claims, 14 contained more than 1 deficiency.

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. On the basis of our sample results, we estimated that the State agency claimed approximately $1.1 million in improper Federal Medicaid reimbursement.

In addition, the State agency did not have adequate support for about $183,000 (Federal share) of costs claimed. The lack of support occurred because the State agency did not have adequate controls in place to monitor the reporting of expenditures claimed for NEMT services.

We recommended that the State agency (1) refund $1.1 million to the Federal Government for improper claims, (2) refund $183,000 to the Federal government for costs claimed without adequate support, (3) strengthen its policies and procedures to ensure that providers comply with all State and Federal requirements, and (4) strengthen its controls over its process for reporting expenditures claimed for NEMT services. In written comments on our draft report, the State agency did not agree with parts of our finding on unallowable claims and described actions that it has taken in response to our finding on inadequate support of costs claimed.

Filed under: Centers for Medicare and Medicaid Services