Office of Inspector General Partnership with the State of Ohio, Office of the Auditor's Report on Review of Medicaid Provider Reimbursement Made to Crest Transportation Service

This audit was made by the Ohio Office of the Auditor and was provided to us as part of the Inspector General's partnership efforts with States to expand audit coverage of the Medicaid program. The State Auditor's final report points out that Crest Transportation Service was unable to provide documentation for a statistical sample of Medicaid transportation services billed during the period January 1, 1996 through March 31, 2000. Because of the lack of documentation--no support that trips occurred, missing physician certifications to support the medical necessity of any trips, and other evidence--the State Auditor questioned $1,001,675 (Federal share approximately $590,000) in provider reimbursements during the audit period. The State Auditor recommended that the Ohio Department of Human Services determine whether the overpayments constitute fraud and abuse, initiate proceedings to recoup all or part of the overpayments, and consider termination of the provider's Medicaid agreement. The case was referred to the Ohio Medicaid Fraud Control Unit for investigation and possible legal action.