A Performance Audit
An Audit Report on the Health and Human Services Commission's Oversight of the Medical Transportation Program
The Health and Human Services Commission (Commission) established various monitoring processes for its nonemergency Medical Transportation Program (transportation program).
Transportation Claims. The Commission’s processes ensured that transportation claims were for eligible clients. However, it did not effectively monitor transportation claims submitted by providers.
Monitoring Provider Compliance. The Commission should strengthen monitoring processes to address significant weaknesses in (1) all five desk review types tested, (2) investigating client-reported accidents/incidents, and (3) closing client complaints.
Information Technology Controls. The Commission had certain application information technology controls over its Accidents/Incidents database and its HHS Enterprise Administrative Report and Tracking (HEART) complaints system. However, it should improve controls over date fields in its Accidents/Incidents database to increase the reliability of the data.
Transition to New Model. The Commission ensured an effective transition of the transportation program to the Medicaid Managed Care Organization model for Medicaid managed care members as of June 1, 2021.
The Commission Monitored Claims to Ensure That Clients Were Eligible to Receive Transportation Program Services
To obtain payment, transportation providers must submit claims to the Commission. The Commission’s process for monitoring claims verified that individuals receiving program services were eligible clients.
The Commission Did Not Consistently Monitor Claims to Verify That Clients Received the Transportation Services or That All Mileage Claims Complied with Requirements
To monitor transportation claims submitted by providers, the Commission established an operational review process. However, it did not consistently conduct those reviews since March 2020, including the scheduled reviews of its two largest providers and both Fee-for-Service (FFS) providers. As a result, for 30 (21 percent) of the 145 transportation claims tested, the Commission did not have supporting documentation showing the client received the transportation service. In addition, for 14 (50 percent) of the 28 MTO regions’ mileage claims tested, the Commission did not have documentation showing that the individuals being paid for mileage costs were enrolled.
The Commission Had Desk Review Processes to Monitor Providers; However, It Had Significant Weaknesses in Its Monitoring of Provider Compliance in Certain Desk Review Areas
The Commission has created different types of desk reviews to help monitor providers’ compliance with key areas and protect the clients using the transportation services. Auditors tested five desk review types and identified significant weaknesses that limit the Commission’s ability to identify and address noncompliance.
Untimely Desk Reviews. The Commission conducted four of the desk review types tested (complaints reporting, healthcare claims matching, driver credential and screening, and vehicle registration desk reviews) from 218 days to 535 days after the end of the quarterly or semi-annual desk review period.
Improperly Designed Desk Reviews. The Commission did not properly design the accident/incident reporting and complaints reporting desk reviews.
Inaccurate Review. For one of the three driver credential and screening desk reviews tested, the Commission did not use the appropriate information and identify that certain driver checks had not been re-performed annually.
Lack of Corrective Action Plans or Liquidated Damages. The Commission’s policies and procedures do not provide sufficient guidance for four desk review types on when the Commission should consider implementing Corrective Action Plans and assessing liquidated damages for identified noncompliance.
In addition, the Commission did not follow its policy for the noncompliance it identified in its healthcare claims matching desk reviews.
The Commission Adequately Monitored Provider-reported Accidents/Incidents; However, It Should Ensure That Providers Consistently Investigate and Resolve Client-reported Accidents/Incidents
Although the Commission had an adequate process for monitoring that provider-reported accidents/incidents are resolved, it should improve the design of its process for investigating and resolving accidents/incidents for those cases received from clients. In addition, it should ensure the accuracy and completeness of data in its Accidents/Incidents database.
The Commission Monitored Client Complaints, But It Should Strengthen Its Processes to Ensure That Complaints Are Closed Timely
The Commission monitored client complaints to ensure that there was sufficient resolution and corrective action. In addition, data entry for key fields in the HEART system was accurate and application controls were in place. However, the Commission should strengthen its processes to close complaints within established timeframes.
The Commission Effectively Transitioned the Transportation Program to a Managed Care Organization Model
The Commission effectively transitioned the transportation program to a Managed Care Organization Model as required. However, the Commission had not updated all of its desk review procedures to reflect contract requirement changes.
Graphics, Media, Supporting documents