MedRide files injunction in court to halt contract suspension with Colorado Medicaid office

COLORADO, USA (KRDO) - Documents shared with KRDO13 Investigates by a representative with MedRide, outline why the company feels The Colorado Department of Health Care Policy & Financing (HCPF) is wrongly suspending their contract over accusations of "waste, fraud and abuse." and are asking a judge to block the move.

The documents filed officially on Thursday, February 6, through a law firm based in Denver, represents MedRide LLC. Their first claim is that the HCPF's use of a Colorado statute to suspend their contract, does not apply to them as a company, and that they have not provided any factual findings of what they're alleging, in terms of fraud.

MedRide also alleges they were improperly given notice about the suspension, which was only delivered to them on January 31, eight days before the suspension's start date of February 7.

Previously an HCPF spokesperson told KRDO13 that C.R.S. § 25.5-4-301(16), allows them to suspend Non-Emergency Medical Transport (NEMT) providers in order to give the office time to investigate provider behaviors typically associated with fraud, waste and abuse, saying their suspension of MedRide meets the criteria in state law.

However, MedRide claims in court filings that part of that statute does not apply to them, because they are a provider that has been enrolled in the state medical assistance program, including the children’s basic health plan, for more than three years, consistently rendering services and being compensated for it by the state.

They explain that MedRide has been an enrolled provider with HCPF since 2018, much longer than three years.

However, the Colorado statute, in its entirety, reads as such:

• The provider has been enrolled in the state medical assistance program or children’s basic health plan for less than three years;
• At least three providers are involved in the scheme;
• The collective billing amount identified in the scheme exceeds $1 million;
• The provider's billing indicates a pattern of abuse or noncompliance as defined in 10 C.C.R. 2505-10, Section 8.076.1.1;
• The volume of claims has increased at a significant rate and there is no other reasonable explanation for the increase;
• The Centers for Medicare and Medicaid Services has approved a provider enrollment moratorium for the provider type involved in the scheme; or
• HCPF has notified law enforcement of the scheme.

Previously, a MedRide spokesperson has claimed that there is no fraud that has been committed by their company. That person admitted that there have been forms filled out by their drivers that were missing member signatures, missing dates and times, or were missing entire columns of data, but argued that calling those instances monetary fraud was inappropriate.

The other primary claim of the legal filings discusses the negative impact it will have on Coloradans.

MedRide explains that in 2024, their revenue totaled $51,249,938, and recorded 375,514 rides for clients. By their estimate, in the first six months of 2024, MedRide provided approximately 69.5% of rural Colorado NEMT trips, "for Program members in rural areas, who are often underserved and are in the greatest need of such services because of their distance from necessary medical treatment locations." as quoted in the documents.

That statement rings true for one family who KRDO13 Investigates spoke with this week, who hails from Cañon City. Debra Newman says her son has to travel to an Aurora hospital for the only doctor in the state who can treat his rare blood disease, and MedRide was the only company she knew who would make the 2 hour and 15 minute drive both ways.

Their final claim is a judgement of 100,000 dollars, for the HCFP to pay MedRide, due to what a MedRide spokesperson claims has been upwards of $70,000 dollars of un-compensated rides and services by the State, that MedRide has provided to clients leading up to the suspension deadline.

According to documents from HCPF, the suspension is effective for an initial period of six months while the office continues its review of the alleged scheme. It says that they may terminate, or extend, the six-month suspension, or terminate MedRide as a provider altogether, as the investigation continues.

KRDO13 Investigates will continue to follow this story