State lost millions in Medicaid transportation fraud scheme; patients, drivers still feeling the effect

COLORADO SPRINGS, Colo. (KRDO) - Many Medicaid patients and Non-Emergent Medical Transportation drivers are feeling the effect of a statewide investigation into a multi-million dollar Medicaid transportation fraud scheme.

According to the Colorado Department of Health Care Policy and Financing (HCPF), some Non-Emergent Medical Transportation (NEMT) providers were filing false or fraudulent claims. For example, some transportation services would pick up multiple patients in Southern Colorado, and in one trip, drive them to clinics in Denver rather than available ones in Pueblo or Colorado Springs. These drivers would then file claims for thousands of dollars on just that one trip.

The state also said there are cases where NEMT providers would find Medicaid members’ information and bill the state for rides that never happened. As word spread of this scheme, the state saw an “unprecedented surge of provider enrollment applications within a few months

of each other, much higher than the normal number of applications the Department receives over the course of a year.”

In response, the state placed some NEMT providers on a payment review and implemented a temporary moratorium, meaning the state would not accept new or pending NEMT applications. That moratorium was extended on April 1 for another six months.

Demetrius Jefferson, the owner of Dee Transportation Co., was one of the NEMT providers placed on a payment review. He said he logged into the state portal in February and saw he wasn't paid. He, along with many other NEMT providers, now must be revalidated and credentialed in order to be paid for their services.

“They just cut me off,” Jefferson said. “It's pretty much got me in dire straits right now.”

Jefferson said he started the revalidation process and continued to drive patients to their appointments, hoping he would be approved and reimbursed within a couple of weeks. However, three months later, Jefferson still hadn’t been paid and decided to temporarily suspend his services.

“Quite a bit of bills that aren’t being paid,” Jefferson said about how suspending his service has affected him. “I have just been fluctuating through my savings. It pretty much came to an end with the withdrawal of that, so we'll have to figure some things out now.”

Now his clients are left figuring out how to get to their appointments.

“I've had to cancel appointments,” said Heather Johnson. “That's not good, because I have a lot of health things going on and scattered rides and things like that. That's a problem.”

“I have to call and rearrange my appointments and some of my appointments are not that easy to rearrange,” said Lisa Newsome, one of Jefferson’s clients.

The state said there are currently 200 active NEMT providers in the state, which patients can use. However, Jefferson’s clients said many of them are unreliable.

“They'll drop you off and then they don't come get you and you're stranded,” Johnson said.

Meanwhile, there are about 230 NEMT providers waiting to be revalidated and credentialed by HCPF’s transportation network broker, Transdev Health Solutions. The state said there is no timeline on when these providers will be able to continue their services.

The Colorado Bureau of Investigations is looking into these fraudulent Medicaid transportation claims, but they declined to comment on the active investigation.

“NEMT transportation is a lifeline for a lot of us,” Johnson said. “So not having that, it's a trickle-down effect. You miss one appointment, it's not good.”