Evidence record
Review of Medicaid Provider Reimbursements made to Crest Transportation Service
- Jurisdiction
- Ohio
- Publishing agency
- Ohio Auditor of State
- Publication date
- June 29, 2000
- Source record
- Original document linked
Findings
8
Recommendations
4
Overall conclusion
The review identified significant non-compliance with Medicaid reimbursement rules by Crest Transportation Service, resulting in overpayments and raising concerns about potential fraud and abuse. The provider’s documentation deficiencies, billing irregularities, and the owner’s receipt of Medicaid benefits warrant further investigation and corrective actions.
Scope
The review covered Medicaid transportation services rendered by Crest Transportation Service from January 1, 1996, to March 31, 2000, including claims submitted, documentation, and provider practices related to billing, medical necessity, and eligibility.
Findings (8)
Each finding has a stable link.
- F-065
The provider submitted claims for services that did not meet reimbursement rules, resulting in overpayments of $1,001,694.70.
- F-066
Lack of documentation to support trips, medical necessity, and other required records.
- F-068
Many recipients transported were ambulatory, contrary to Medicaid rules for ambulette services.
- F-069
Multiple transports were billed as individual transports when they were likely multiple passengers in one vehicle.
- F-070
The provider’s agreement was not current and was signed by an unauthorized person.
- F-071
Many transports were not for Medicaid-covered services.
- F-072
The owner of Crest Transportation also received Medicaid benefits, which raises concerns about eligibility and potential fraud.
- F-067
Physician’s certifications for medical necessity were missing.
Recommendations (4)
- R-094
Determine whether the overpayments constitute fraud and abuse and initiate recoupment proceedings.
Related finding F-065 - R-095
Terminate the provider’s Medicaid agreement if appropriate.
Related finding F-070 - R-096
Investigate the Medicaid eligibility of the provider owner.
Related finding F-072 - R-097
Suspend Medicaid payments to the provider until issues are resolved.
Related finding F-065