An Audit Report on the Medical Transportation Program at the Texas Department of Transportation
October 2007
Report Number 08-006
Overall Conclusion
The Texas Department of Transportation (TxDOT) implemented procedures in February 2007 for monitoring the transportation providers for its Medical Transportation Program to ensure that the providers comply with contract requirements and that transportation services are provided to eligible recipients.
The Medical Transportation Program provided non-emergency transportation to health care appointments to 196,308 eligible recipients in fiscal year 2007. However, TxDOT has not followed the scheduled monitoring required by its procedures. Further, these procedures do not include a risk assessment process that would help TxDOT identify high-risk transportation service areas and more effectively focus its monitoring resources. Because of this, TxDOT does not ensure (1) that transportation providers consistently comply with contract requirements, such as checks of drivers' criminal histories and provider's insurance levels, or (2) that eligible recipients receive medical transportation services in a timely manner.
Sixteen percent of the drivers' records auditors tested at four of the largest transportation providers indicated that the drivers had criminal backgrounds that would disqualify them from driving under TxDOT's contract requirements.
TxDOT's Medical Transportation Program operates three call centers that schedule transportation, advance funds to individual drivers or their attendants, and record complaints received about medical transportation services. However, TxDOT has not developed standard operating procedures for its three call centers-located in Dallas, McAllen, and San Antonio-to ensure that accurate and consistent information is provided to eligible recipients. Further, the call centers do not conduct sufficient monitoring of their call takers to ensure that accurate information is captured, advance funds are distributed to eligible recipients for eligible services, and all complaints received are recorded and processed in a timely manner. In addition, factors prevented auditors from being able to determine the accuracy of performance targets used to measure the performance of the call centers.
TxDOT's financial reporting for its Medical Transportation Program is substantially accurate, and TxDOT has taken steps through its procurement process to minimize its risk of paying unreasonable rates for medical transportation services.
Surveys auditors conducted in June 2007 and July 2007 of Medical Transportation Program eligible recipients, transportation providers, and transportation providers' subcontractors indicated that a majority of them were satisfied with the operations of the Medical Transportation Program, although some needed improvements were identified.
The Medical Transportation Program is being transferred from TxDOT to the Health and Human Services Commission (Commission); however, TxDOT will continue to operate the Medical Transportation Program until the transition becomes effective no later than September 1, 2008. As the program goes through its transition to the Commission, TxDOT should continue to ensure that proper controls are in place to ensure that contractors consistently comply with contract requirements.
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