The Office of the Medicaid Inspector General (OMIG) and the New York City Human Resources Administration (NYCHRA) announced findings of more than $4 million as a result of an audit of Medicaid transportation provider Alert Ambulette, located at 2702 Stillwell Avenue in Brooklyn, New York.

The audit assessed this provider’s compliance with the laws, rules, and regulations of the Medicaid program. Alert received $5,238,370 for 89,847 services rendered to 6,993 Medicaid enrollees.  Auditors reviewed a random sample of 100 services involving 91 Medicaid enrollees to reach its conclusions.  The total amount expected to be recovered is $4,028,190.

The auditors discovered practices ranging from improperly licensed and/or registered vehicles, inappropriate procedure codes used for billing, and inaccurate or missing information on claims.  In more than 50 percent of the claims examined, license plate and/or driver’s license number information was missing.  In more than one-third of the claims, drivers were unlicensed by the New York City Taxi & Livery Commission (TLC), a Medicaid as well as New York City requirement for ambulette drivers.

This audit was conducted as part of OMIG’s County Demonstration Program, a state and local partnership committed to finding fraud, waste, and abuse in the Medicaid program.  Audits under this program are conducted at the local level using protocols and standards created by the Office of the Medicaid Inspector General.  OMIG issues the final report and seeks appropriate restitution from providers who have received Medicaid funds.

Medicaid Inspector General James Cox said, “Medicaid should never foot the bill for services that fail minimum standards.   Retrieving taxpayer dollars when we identify a problem like this is what we do every day.”

“HRA staff work with the OMIG to audit providers who violate Medicaid program rules, and audits like this send a message to the Medicaid community that someone is watching,” said HRA commissioner Robert Doar. “We value our partnership with New York State and are proud to use our staff’s unique knowledge of New York City neighborhoods and skills to help weed out fraud, waste, and abuse in New York City’s Medicaid program.”

The New York State Department of Health (DOH) now uses a transportation broker to more closely monitor the usage of ambulette services in New York City. 

Auditing transportation providers is one of OMIG’s major initiatives, as found in the 2013-14 OMIG Work Plan, published on the OMIG Web site (www.omig.ny.gov).  The New York City HRA, through the County Demonstration Program, has partnered in this instance with OMIG to ensure that this priority remains active in the metropolitan New York area as well. 

OMIG appreciates this opportunity to work with the New York City HRA on behalf of the taxpayers of New York State with the goal of detecting Medicaid fraud and abuse and recovering misspent funds for the Medicaid program.