Friday, May 26, 2000
Ambulance firm owes $861K, Ohio says
Company disputes total
By Tim Bonfield
The Cincinnati Enquirer
Medic One Inc., a large local ambulance service, has been ordered to return $861,100 in Medicaid payments after a state audit found numerous cases of double-billing and improperly authorized charges over a three-year period.
The Medic One case was the largest of three ambulance company audits announced Thursday by state auditor Jim Petro. Combined, the cases involve $1.5 million in alleged overpayments.
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MEDICAID OVERBILLINGS
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A state auditor's report found three ambulance companies lacked the paperwork to justify about $1.5 million in Medicaid payments over three years.
• Medic One, Cincinnati: $861,100.
• Wheelchair Limousine, Columbus: $297,000.
• Apple Lane Ambulette Service, Mansfield: $345,900.
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Also named were Wheelchair Limousine in Columbus and Apple Lane Ambulette Service in Mansfield.
“These providers must initiate internal controls to ensure proper documentation and billing procedures are followed at all times,” Mr. Petro said.
The companies have 45 days to either pay, negotiate a settlement with the state department of human services (which runs the Medicaid program) or sue.
Jacky Hendrix, corporate collections and billing officer for Medic One, said her company hopes to negotiate a lower repayment.
“This is not final,” she said. “It will end up lower than $861,000.”
Medic One, headquartered in Cincinnati, has ambulance services in Ohio, Michigan and Tennessee as a result of mergers in recent years. Much of its business involves hauling wheelchair-bound and medically frail people to nursing homes, hospitals and doctors' offices.
Last fall, the company reorganized. A new board of directors and new top officers (including Ms. Hendrix) came in.
In the transition, it has been difficult to find records the state auditor wanted to see, Ms. Hendrix said.
“What we've got here is new people trying to find old paperwork,” Ms. Hendrix said. “We may not have done a great job of keeping records. But in no way did we bill for a run we didn't do.”
The three ambulance companies were among a dozen in Ohio that attracted audits after red flags popped up on routine computer analysis of Medicaid payments, said Kim Norris, a spokeswoman for Mr. Petro.
While not commenting on any specific case, the kinds of things that attract attention include sudden increases in billings and unusual percentages of payments assigned to certain billing codes, Ms. Norris said.
The payment sought from Medic One amounts to about 23 percent of more than $3.7 million in Medicaid payments made from Jan. 1, 1996, through March 31, 1999.
The audit started by combing through billings for a randomly selected 30-day period. In 1,057 of 4,651 records checked, the auditor could not find original copies of required physician certification forms. It also found no documentation for 164 runs, no trip logs for 29 runs, and 386 cases where the company received payment twice for the same run.
The double billings prompted a more extensive computer search, which led to 11,290 cases of double billing that totaled $91,363.
To get to $860,000, the auditor projected the number of improper billings found in the 30-day check over the entire three-year period.
Ms. Norris said this auditing method has been in place for years. But Ms. Hendrix questioned its fairness.
“They take a small sample and extrapolate over a number of years. It blows it all out of proportion,” she said.
The double billings in the auditor's report were not intentional, Ms. Hendrix said. Instead, they reflected the state being slow to pay the first bill, the company re-billing for the service, and then the state paying both bills.
John Allen, spokesman for the Ohio human services department, said the state is not alleging any fraud occurred. But the state wants the money back, he said.
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