Most Medicaid overpayments never recovered

2/27/2018

COLUMBUS — Transportation, home health-care, and other service providers found to have been paid for Medicaid services they couldn’t prove they provided have repaid just a fraction of what they owe, state Auditor Dave Yost said Tuesday.

OBJECTHe’s thrown his support behind Senate Bill 218, which would require many such providers to acquire surety bonds, an insurance policy backing up their work, as a condition for participating in the federal-state health-care program of last resort for the poor, infirm, and disabled.

That would give the state another option to recover money paid to providers who can’t supply proper documentation for their billings, have workers who lack required training or certification, or billed for services provided without prior authorization.

Over the past seven years, the auditor’s office flagged $33.3 million in improper payments, plus $2.4 million in interest, to 121 Medicaid providers. A recent review of 60 of those previously flagged providers showed that they’d repaid just $1.9 million of $19.7 million owed as of November, 2017.

“That’s about 9.6 percent paid,” Mr. Yost said. “Over 90 percent of the money we’re not getting back.”

State Sen. David Burke (R., Marysville), whose district stretches north to Sandusky Bay, chairs the Senate committee considering Senate Bill 218, sponsored by Sen. Peggy Lehner (R., Kettering). He noted that surety bonds would not be required of family members who receive Medicaid payments to care for someone in their own home.

“But yet you can set up a home health-care agency or a transportation agency… not even be located in the state of Ohio, and provide those services, and yet have no recourse by the state on fraudulent billing issues,” he said. “They just close up shop in the state and leave.”

Mr. Yost said relatively few cases of suspected fraud end up in criminal court. The bill has yet to have its first hearing, but Mr. Burke said there has already been some push-back by some Medicaid providers.

The state attorney general, the office for which the Republican Mr. Yost is now running, serves as the state’s debt collector.

In 2016, the Ohio Department of Medicaid paid providers $22.3 billion for their services. Some 3 million Ohioans receive some Medicaid service every day, and the state has nearly 111,000 active Medicaid providers.

Mr. Yost said his office has found cases in which drivers being paid to provide transportation services lacked drivers’ licenses, and home health-care workers lacked basic first-aid training.

“The notion that we’re going to let you catch up with your certifications later and we’re going to pay you in the meantime is a profoundly stupid idea,” Mr. Yost said.

Transportation and home health-care workers make up at most 17 percent of the total Medicaid service providers, but they accounted for $28.7 million, or 86 percent, of the $33.3 million in overpayments identified since 2011.

The top finding against a Medicaid provider involved Great Nursing Care, Inc., in Franklin County, which was found to owe the program $5.2 million in findings and interest. None of the top 10 findings involved agencies in northwest Ohio. 

But Mr. Yost’s report pointed to Citywide Medical Transportation in Lucas County as an example of a service provider found in 2016 to be have been overpaid $182,381, some 84 percent of the nearly $216,000 it was paid by the state during the review period. The company has yet to make a payment.

The problem was chiefly due to incomplete or improperly completed authorization records.

Contact Jim Provance at: jprovance@theblade.com or 614-221-0496.