Investigation Uncovers Fraud in Ohio Ambulette Industry

Companies inflating number of trips and costing Medicaid millions


 
 

JOSH SWEIGART and KEN MCCALL, Dayton Daily News | | Monday, April 28, 2014


An investigation by this newspaper found that a tool to catch fraud in the ambulette industry is often ineffective because it is based on self-reported information that can be wildly inaccurate. Ambulettes often are used to take patients to and from dialysis centers, such as this one in Dayton.

Eaton Medical Transport reimbursed the state $3,238 after a 2008 audit showed it had overbilled Medicaid over a three-year period in which it received $1.7 million for medical transportation provided to Medicaid clients.

A Columbus-based company billed Ohio Medicaid $316,775 for wheelchair transports last year, which means its one licensed vehicle would have had to log an average of 29 trips or 268 miles every day of the year.

The company, Rapid Medical Transport, reported almost twice as many trips per vehicle and nearly 100 miles more per day than any other company in Ohio. But owner Ahmed Gardaad didn't raise any eyebrows at the state level when he renewed his ambulette license in October, because the agency that issues those licenses was given drastically lower numbers for the number of trips the company made.

Gardaad told the Ohio Department of Public Safety that he provided 73 trips last year - not the 10,425 trips for which he billed Medicaid.

This is one of numerous examples uncovered by the I-Team of ambulette companies that bill Medicaid while listing false information on their license applications. The public safety department's Division of Emergency Medical Services, which licenses medical transportation companies, says it doesn't have access to Medicaid billing data to flag possible cheaters.

Rapid Medical Transport was suspended by Medicaid in January pending an investigation. According to a notice sent to the company, Medicaid "determined that a credible allegation of fraud exists based on evidence that your company submitted claims and received reimbursement for Medicaid services that you did not provide."

Rapid Medical Transport has not been fined or charged with any kind of fraud or wrongdoing. Ohio Medicaid officials won't elaborate on the allegations, and Gardaad did not return calls for comment.

Ambulette companies have provider agreements allowing them to bill Medicaid for transporting people in wheelchairs to non-emergency medical appointments, such as dialysis. Each trip paid by Medicaid represents one passenger. Medicaid pays $23.59 per passenger - and less for each subsequent passenger taken at the same time - and 70 cents per mile for a wheelchair van, or ambulette.

Companies avoid scrutiny, this newspaper found, by grossly under-reporting to the state how many trips they provide each year.

The Affordable Care Act identified ambulette fraud as one of four leading Medicaid fraud concerns. Officials from the Attorney General's Office, Ohio Medicaid and State Auditor's Office have expanded efforts to detect this fraud by using data analysis similar to the methods used by this newspaper.

Officials from seven companies in Ohio were criminally convicted last year in state and federal courts. Two more have been convicted this year, and officials from three companies currently are facing charges.

The AG has 57 open investigations of ambulance and ambulette companies.

$10.8 million overbilled

An I-Team analysis of state data discovered that 29 of 30 state audits of ambulette companies conducted since 2007 found overbilling of Medicaid. The total amount allegedly overbilled was $10.8 million.

Ohio Medicaid paid 251 companies for ambulette transports in 2013, according to an analysis of Medicaid billing data by this newspaper.

Medical transportation cost Medicaid more than $67.3 million in fiscal year 2013. Medicare paid 773 ambulance service providers a combined $220.2 million in calendar year 2012.

Dayton-based Nubta Trans reported in October that it provided zero trips the prior year. But company owner Hashim Salih billed Medicaid $71,881 for 3,048 tips. Nubta has only one vehicle, which is licensed to operate in Clark, Greene and Montgomery counties.

Numerous messages left with Yousef Ahmed, operator of Nubta Trans, were not returned. Visits to Nubta's office on Frederick Pike in Dayton found a locked door with a Nub-ta sign on it.

When Antwain Hamilton renewed the EMS license for his company, Star Medical Transportation, in January 2013, he listed two licensed ambulettes and told the state they provided 627 one-way trips in 2012.

But from July 2012 through June 2013, Star Med billed Ohio Medicaid for 6,142 trips - a total of 165,648 miles. Every trip also billed for an extra attendant, which is not usually required. In total, the company billed Medicaid for $316,183 that year.

Federal charges filed against Antwain and Temeca Hamilton in January allege that they over-billed Medicaid by $750,000, dating back to 2010. The indictment says they billed for services that were never provided, including mileage and the service of an extra attendant that wasn't used or needed.

Some of these bills were for trips allegedly taken when the Hamiltons were traveling out of state, according to the indictment. It also says they transported patients that didn't require or use a wheelchair.

Star Med is one of three companies currently charged with ambulette fraud. The others: Humberto Caballero from the Akron area is charged with theft of more than $150,000, and a Cincinnati woman, Sherrelle Knuckles, is charged with theft of more than $7,500.

Caballero had one vehicle licensed with the state in July 2013, and billed Medicaid $43,311 during the state's fiscal year 2013.

Jayne Barnes, owner of Hometowne Transportation, which operated in southwest Ohio and was based in Hamilton County, pleaded guilty to health care fraud in May 2013.

Hometowne Transportation received more than $2 million from Medicaid from 2005 through February 2009, billing for roughly 62,000 trips. Court records say Barnes is accused of improperly billing for $225,840 of that total.

Barnes was sentenced to a year in prison followed by three years of supervised release and ordered to pay restitution for the full $225,840.

$100K per vehicle

Rapid Medical Transportation and Star Med ranked one and two last year for the amount of money billed Medicaid for each vehicle licensed to transport people in wheelchairs. Rapid Medical is licensed for a single vehicle, a Ford E-250, while Star Med is licensed for a Ford E-350 and Dodge Caravan.

Just behind Star Med in the rankings was 1 Safe Transportation, based in Cincinnati. That company's one vehicle earned $149,193 from Medicaid that year, billing for 4,438 trips totaling 63,592 miles.

When 1 Safe Transportation renewed its license in January 2013, it reported that it had provided 252 one-way trips the previous calendar year.

When asked about this discrepancy, company owner Craig Spraggs said, "I have to look at my paperwork."

Spraggs said he is the only driver. When asked how many trips he provides on average, he said he didn't know. When asked how many trips he provided the previous day, he said, "I have to look at my paperwork."

In fourth place is Stevenson Transportation in Cuyahoga County, which has one vehicle. The company billed the state $146,128 for 5,498 trips. It reported to Ohio EMS in August that it provided only 662 trips the previous year.

Friendly Touch Medical Transportation, which billed $284,782 for 10,811 one-way trips, ranked fifth in the state for per-vehicle Medicaid billings. The company has two licensed ambulettes, each grossing an estimated $142,381.

Friendly Touch owner Bobby Price said he has four vehicles but only two are used for wheelchair trips. He said his vehicles run seven days a week, making eight or nine round trips - mainly to dialysis appointments.

"Some of them work six or seven hours a day, some of them work eight hours a day," he said. "I'm not doing anything funny with the paperwork."

Price said he currently is being audited by the state and is having trouble because one of his ambulettes has a faulty odometer. He also said his wife left him and took with her a bunch of the company paperwork.

Price's Ohio EMS license application in August 2013 left blank the line asking how many transports he provided last year.

"I probably didn't fully understand the question," he said.

'Very concerning'

The newspaper's investigation found 11 ambulette companies, including Nubta of Dayton, that billed Medicaid even though they listed on their license renewals that they provided no ambulette trips last year.

Three left the line blank, though they billed Medicaid for thousands of trips combined.

"The number of wheelchair transports is collected to assist with reporting fraud," wrote Ohio Department of Public Safety spokeswoman China Dodley in a written response to this newspaper's questions. "In the event that it is noticed that the number of trips compared with the number of units is not feasible, the Attorney General's office is notified."

Dodley admitted, however, that her office does not have access to state Medicaid data, so it doesn't know whether the numbers being reported are accurate.

"This is very concerning," said state Sen. Shannon Jones, R-Springboro, chairwoman of the Senate committee that oversees Medicaid.

Jonathan Ollenn, owner of Ollebert Medical Transportation in Cleveland, blamed confusion for the under-reporting on his application. He reported two trips last year, yet billed Medicaid for more than 3,000. Ollenn said he thought it was asking how many vehicles he had.

He said his two vehicles transport maybe seven people a day, meaning 14 one-way trips.

"I've never added up all the trips I've made," he said.

All of the applications are signed by the company owner under a line that says they "certify that all information provided in this application is accurate and complete."

Dodley said the "board can take disciplinary action if a provider submits false statements on their application."

Trips per day

Of the 50 companies that billed Medicaid for the most miles of wheelchair transports, just four billed for more than 12 trips per vehicle - if they drove 365 days a year. But Ohio EMS officials said they don't have a threshold for the number of trips that would trigger suspicion.

"If a staff member is reviewing an application and sees something that clearly stands out as suspect, for example one unit that lists 20,000 trips ... that would be considered 'not feasible,' " Dodley said.

Some ambulette company operators said the number of trips billed to Medicaid per vehicle seemed like red flags.

"That's too much," said Mustafe Hashi, who drives for a newer company called Buckeye Trans System, based on Columbus. "When you have the wheelchair people, it takes time."

He said he works full-time and averages up to eight one-way trips per day, five days a week.

Trina Adkins, owner of Portsmouth Emergency Ambulance Service in Portsmouth, said her ambulettes run five days a week and do eight-to-10 one-way trips per day.

"You can't do that many," she said when told how many trips the top earners were doing.

Weslava Pikous, owner of Graceful Living LLC near Cleveland, said her three ambulettes could average up to 15 one-way trips per vehicle, per day.

"If one (company) is not playing by the rules, people think, 'They're all cheaters' and we're not," she said. "It's a bad reputation for all of us."

Records in the attic

Ohio auditor's office officials said ambulette services are at "high risk" for fraud - along with home health care - because there is a low bar for entry. All someone needs to start a business is a van with a wheelchair lift and a little training.

The auditor's office watches for billing anomalies and spikes, and audits ambulette companies every year. It has five audits of ambulette companies across Ohio scheduled for release this year.

All six audits released last year included some alleged overbilling, totaling $1.8 million. The largest was the most recent: $930,624 in overpayments alleged by Greathouse Medical Transportation in Cuyahoga County.

State auditors say they had to dig through the company owner's basement, attic, crawl space and storage closet for records to complete the audit.

"The owner admitted to us that the records were a mess because she had relatives help her with filing and because she could not keep up with the paperwork," the audit says.

"I suppose on the bright side the records did, in some cases, exist," Auditor Dave Yost said when the audit was released in November. "But this is no way to run a company that receives tax dollars."

Auditors reviewed records from 2008 through 2010 and found 141 instances in which wheelchair trips were provided by Greathouse with no certificate of medical necessity - as required by Ohio law. It also found 20 instances where the certificates were not valid and hundreds of incomplete or disorganized trip documents.

They found 80 trips where miles billed exceeded miles documented and 374 cancelled trips without proper documentation. Finally, all 11 company drivers tested were ineligible to transport patients because they had incomplete training or background checks.

Yost recommended billing the company $1 million, including $82,404 in interest from the overpayment.

Of the 29 companies accused of overbilling in audits since 2007, seven are in the hearing process and 11 have made payments to Medicaid.

Quality Care Transport of Springfield paid back $93,000 after a 2010 audit alleged it over-billed Medicaid $254,045. The company has 20 vehicles and billed Medicaid $162,792 last year.

Eleven companies with a combined $6.2 million in alleged overpayment have gone to the Attorney General's Office for collections. Most of these companies are no longer in business, though three billed Medicaid for a more than $200,000 combined last year.

Jones commended the work done by state officials to catch fraud, and said they should look into this newspaper's findings.

"Obviously, second only to providing quality care for our residents who are on the system is a need to weed out waste, fraud and abuse," she said. "I would be interested in what the attorney general would have to say about this issue and if there is something we need to do to beef up."

Staff writer Will Garbe contributed to this report.

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