Oklahoma Did Not Adequately Oversee Its Medicaid Nonemergency Medical Transportation Program
The State agency did not adequately oversee its Medicaid Nonemergency Medical Transportation (NEMT) brokerage program to ensure that Federal and State requirements and contract provisions were met. Specifically, Oklahoma's oversight and monitoring of its Medicaid NEMT brokerage program did not ensure that (1) drivers attended required training courses and had their records reviewed by their employers, (2) transportation services were adequately documented, (3) vehicles used to transport Medicaid beneficiaries met State requirements and standards, (4) beneficiaries received Medicaid-eligible medical services on the date of transportation, and (5) transportation services were provided. Of the 100 claims in our random sample, 58 complied with Federal and State requirements and contract provisions, but the remaining 42 claims did not.
On the basis of our sample results, we estimated that LogistiCare Solutions, LLC, the contractor that served as transportation broker to provide Medicaid NEMT services for the State, reimbursed transportation providers for 128,000 claims that did not comply with certain requirements, and LogistiCare paid $6.9 million for improper claims. In addition, providers' noncompliance with certain Federal and State requirements and contract provisions for the licensing and qualifications of transport personnel and the vehicles they used could have jeopardized the health and safety of Medicaid beneficiaries.
We recommended that Oklahoma (1) improve its oversight and monitoring of its Medicaid NEMT brokerage program by requiring LogistiCare to strengthen its procedures to ensure that it meets Federal and State requirements and contract provisions, and (2) ensure that contracts with the transportation broker contain provisions that consider improper claims to the transportation broker when developing future NEMT payment rates and provide a means for Oklahoma to recoup funds from the broker when Federal requirements and contract provisions are not met - a measure that, if incorporated, could result in cost savings for the Medicaid program.
The State agency agreed with our recommendations and described actions it had taken or planned to take to address the recommendations.
Filed under: Centers for Medicare and Medicaid Services