Nebraska Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Transportation Program
The Nebraska Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NET) services claims submitted by NET providers that cannot comply with Federal and State requirements during fiscal years (FYs) 2012 through 2014. On the basis of our sample results, we estimated that the State agency improperly claimed at least $1.9 million (Federal share) in unallowable Medicaid reimbursement for NET services during this period. In addition, NET providers did not have documentation to support that State-mandated driver background checks, vehicle maintenance checks, and driver qualification verifications was performed.
These errors occurred because the State agency's policies and procedures did not ensure that NET providers complied with Federal and State requirements for documenting and claiming NET services. Additionally, the State agency's policies and procedures do not ensure that NET providers maintained documentation to support that driver and vehicle checks were performed in accordance with State requirements.
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We recommended that the State agency (1) refund to the Federal Government $1.9 million (Federal share) in estimated overpayments for NET claims that were in error and did not comply with Federal and State requirements; and (2) strengthen its policies and procedures to ensure that transportation services are provided only to recipients who are receiving Medicaid-covered services on the dates that they are receiving NET services; NET providers maintain records documenting that recipients are actually transported in the vehicles for all trips on the dates that NET services are rendered; NET providers maintain records to document the services provided; it does not pay NET providers or claim Federal reimbursement for non-covered transportation services; NET providers complete the required background checks on all potential drivers before permitting them to render NET services and annually thereafter, and maintain documentation of these checks; NET providers maintain records of all vehicle maintenance checks; and NET providers maintain documentation verifying that their drivers are qualified with current and valid driver's licenses.
In written comments on our draft report, the State agency disagreed with most of our findings and provided additional documentation regarding some of the errors that we had identified in our draft report. The State agency described corrective actions that it had taken or planned to take but disagreed with our estimate of the improperly claimed costs. After reviewing the State agency's comments and the additional documentation, we revised some of our findings, our statistical estimate, and the dollar amount conveyed in our first recommendation. We maintain that our remaining findings and our revised recommendations are valid.
Filed under: Center for Medicare and Medicaid Services