COMPTROLLER'S AUDIT FINDS COUNTY DEPARTMENT
APPROVED UNNECESSARY, OVERPRICED TAXI AND AMBULANCE RIDES
FOR MEDICAID RECIPIENTS

The cost of providing non-emergency transportation for Medicaid recipients in Nassau County, which totaled approximately $26.7 million over the last two years, could be reduced substantially, according to an audit released today by Nassau County Comptroller Howard Weitzman.

"State regulations require that essential, medically necessary and appropriate transportation be provided to Medicaid recipients," Mr. Weitzman said. "Yet our auditors found that the county's Department of Social Services (DSS), by failing to monitor its contractor, Globe Ground, often approved taxi and ambulance rides for recipients in need of non-emergency medical care without determining whether they could have used their own vehicles or public transportation. We estimate this came at an extra cost to taxpayers of at least $1 million per year, and possibly twice that amount."

"Medicaid recipients often require assistance with transportation costs to get the medical care they need, and the Medicaid program provides a critical safety net in this regard. But there is no excuse for wasting taxpayer money by providing taxis and ambulances for routine medical visits to those clients who have access to private autos."

Mr. Weitzman commended County Executive Thomas R. Suozzi, who yesterday announced a new program to curb Medicaid fraud and abuse. "We're glad to see that the County Executive has recognized that the county's share of Medicaid, which exceeds $300 million a year, is an area where significant amounts of money can be saved."

The responsibility for authorizing transportation for eligible Medicaid clients is divided between Globe Ground and the DSS in-house transportation unit. The in-house unit provides direct reimbursement to clients for the use of private vehicles and public transportation. Globe Ground is responsible for authorizing and arranging for transportation using third-party taxi and ambulance services.

State regulations require DSS to ensure that essential, medically necessary and appropriate transportation is provided, but that no expenditures for taxis are made when lower cost alternatives are reasonably available.

"Contrary to these regulations," Mr. Weitzman said, "DSS has been simply giving Medicaid clients the phone number of Globe Ground to book most of their transportation needs in taxis, ambulettes and ambulances, then not monitoring to see that Globe Ground confirms client eligibility or verifies that the client has a doctor's authorization.

"DSS effectively reduced its own workload by allowing almost all non-emergency medical transportation to be handled by Globe Ground. But, considering that Globe Ground automatically ordered cabs or ambulances for most clients, the Department's transfer of the workload to the contractor comes with a hefty price tag for county taxpayers."

The audit report notes that the department's Web page on Medicaid benefits advises clients that they "must call Globe Ground Corporation" to arrange for non-emergency transportation. (For emergency medical care, clients are directed to call for an ambulance, which is reimbursed directly by the State.) When they do, clients are not consistently advised that their first mode of transportation should be their own vehicle or public transportation, nor are they encouraged to have a friend or relative drive them (for reimbursement).

The audit found numerous instances of the contractor's non-compliance with the terms of its contract with DSS, and an almost total lack of the monitoring by the Department.

"In one particularly vexing example," Mr. Weitzman said, "we found a pattern of overcharges for trips to Hillside Hospital/Long Island Jewish Medical Center, which straddles the Queens/Nassau border. The Department's 95-page taxi rate schedule - a nightmare of complexity in itself, compared to Suffolk County's single page - sets a flat rate of $49.25 for out-of-county trips. Apparently, some taxi companies have gotten into the habit of charging taxi rides to Hillside/LIJ at the "out-of-county" rate. As a result, a round-trip taxi ride that could have cost $10 may result in a trip costing $98.50."

In another example of potential waste of county monies, approximately 16 percent of the nearly 69,000 Medicaid clients listed on the Department's rolls as eligible to receive free transportation were found also to have coverage for medical transportation as members of a managed care program, making them ineligible to receive transportation through the county. The Comptroller's report includes numerous recommendations for corrective action and cost-saving initiatives, including:

• better co-ordination between Globe Ground and the Department's own in-house transportation unit to ensure that all applicable state laws and regulations are being consistently followed;
  
• requiring both in-house and contractor staff to take a more aggressive approach to determining need and eligibility for transportation and encouraging the use of private vehicles and public transportation wherever appropriate;
  
• investigating the use of an automated information phone line that could provide step-by-step instructions for clients, employing a script that emphasizes use of clients' own vehicles and public transportation;
  
• developing an adequate method for monitoring Globe Ground's compliance with the terms of the contract, and investigating the use of contractual means to impose penalties for compliance failures;
  
• instituting internal controls to ensure eligibility of Medicaid recipients to receive transportation;
  
• verify annually that ambulance services are certified by the NYS Department of Health, and that taxi services are in compliance with all local requirements, as required by the contract.

The full report is available here:

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Audit of Nassau County Department of Social Services' Administration of Medical Transportation
( ~ 534 kB - 38 pages )