Blunt wants answers after man dies waiting for Medicaid ride

Source: KCS
Credit: The Associated Press
Friday, November 11, 2005
Edition: METROPOLITAN, Section: METROPOLITAN, Page B4

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By David A. Lieb

JEFFERSON CITY - Gov. Matt Blunt on Thursday ordered a review of Medicaid transportation procedures after the death of a southwest Missouri man.

Willie Reed, 63, was found dead Tuesday evening at his home in Republic. The kidney-transplant patient was supposed to have been picked up early that morning by a state Medicaid transportation provider to meet with doctors at a St. Louis hospital.

The ride apparently never showed up.

A friend, Agnes Hayward, found Reed dead near his front door with his packed bags, Springfield television station KOLR reported Wednesday. Republic police investigators think Reed died before his scheduled 4 a.m. pickup by OATS Southwest, the TV station reported. But that is under review.

"We want to find out exactly the timeline of events in terms of when he requested a ride, when the service provider was notified he needed a ride, why he wasn't given a ride and what kind of procedures LogistiCare is using to notify its subcontractors when a ride is needed," Blunt spokesman Spence Jackson said.

Atlanta-based LogistiCare Solutions LLC took over the state's $25.6 million contract for nonemergency Medicaid transportation services Saturday. But it had trouble negotiating arrangements with some of the subcontractors who previously worked with Lake St. Louis-based Medical Transportation Management Inc.

Tuesday was supposed to be the first day OATS Inc. was providing service under the new LogistiCare contract.

Department of Social Services spokeswoman Deborah Scott said LogistiCare had received a request to provide Reed a ride and had referred it to OATS by fax and e-mail. But she said the department knew little beyond that.

The Springfield OATS office referred questions to its Columbia office, and the executive director there did not immediately return a telephone call Thursday.

LogistiCare spokesman Ed Domansky said it was unclear what, if any, connection existed between Reed's death and his missed ride.

"LogistiCare is cooperating with the state in its investigation of this unfortunate incident," Domansky said.

Blunt said he expects a report from the Department of Social Services by the end of the month, which will probably include information from the local medical examiner's office, a timeline of events, details of the contractor's responsibilities, and recommendations.

"My heartfelt sympathies go out to Willie Reed's family and friends," Blunt said in a written statement. "I understand they want answers, and so do I."

First glance

A Republic, Mo., man who was a kidney-transplant patient died while waiting for a Medicaid ride to a St. Louis hospital.

A new Missouri Medicaid transportation provider took over Saturday. It had trouble making arrangements with some subcontractors who had worked with the previous provider.

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Missouri plans investigation into Medicaid transit

By Kelly Wiese

Source: KCS
Credit: The Associated Press
Thursday, November 3, 2005
Edition: MID-AMERICA, Section: METROPOLITAN, Page B8

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JEFFERSON CITY - Gov. Matt Blunt's administration asked the attorney general Wednesday to look into concerns that companies are breaking the law in negotiations with the firm that gives Medicaid patients rides.

The state in October awarded the contract for nonemergency medical trips for Medicaid patients to Georgia-based Logisticare Solutions LLC.

That company is to start providing rides Saturday.

Blunt's Office of Administration said it heard reports from Logisticare and others that the subcontractors would only negotiate as a group to try and drive up the price, which it said could violate state or federal anti-trust laws.

The attorney general's office "can best decide whether or not there's a problem and what action needs to be taken," Office of Administration chief counsel Henry Herschel said.

Logisticare spokesman Ed Domansky said the company already had found enough van and cab companies to handle 80 percent of the traffic volume expected Monday, when demand is higher.

The company expects to have enough contractors to handle trips Saturday, but the issue still needs to be investigated, he said.

Some subcontractors complain that the new contract's rates are too low and that the potential fines for running late are too high for them to work for Logisticare.

Sondra Smith, who owns J&S Medical in Clinton, said Logisticare won't negotiate with her or other businesses.

"The contract is so designed that they will be keeping all the money and the vendors get nothing," she said.

The Missouri Transportation Coalition, which includes about 40 vendors, has an attorney to help with contract negotiations, but Smith said that each company has its own requirements and costs, and that there wasn't a set of demands from the entire group.

"We're not price fixing; we're not colluding," she said.

Domansky said the company is trying to work with vendors.

"We have been reaching out for several weeks now to every possible transportation provider, inviting them to be part of our transportation network," he said.

"Some of them have not returned phone calls, or some have actually said they won't work with us."

Administration Commissioner Michael Keathley said in his letter that the subcontractors' actions could make it difficult to provide the transportation service.

Attorney General Jay Nixon's office said only that it had received the letter but not the contract Wednesday afternoon.

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Medicaid contract awarded

Source: KCS
Credit: The Kansas City Star
Thursday, October 6, 2005
Edition: METROPOLITAN,
Section: METROPOLITAN, Page B3

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JEFFERSON CITY - Missouri awarded a contract Wednesday for medical transportation services for the poor, choosing a company that won the business last year but lost it after protests by another bidder.

The Office of Administration said it chose Atlanta-based LogistiCare Inc. for the new contract to provide Medicaid patients with nonemergency rides to places such as doctor's offices.

The contract will cost the state $25.6 million a year.

That compares with $40.4 million the state paid in the last fiscal year to the current contractor, Medical Transportation Management Inc. of Lake St. Louis, Mo.

Last week, the attorney general's office announced that Medical Transportation Management was paying $2.4 million to resolve a state investigation.

Attorney General Jay Nixon said he looked into concerns about Medicaid fraud, contract problems and antitrust violations.

MTM said its contract had been a good deal for the state, which paid a flat monthly rate even as the clients served and the number of trips grew.

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Audit finds overspending for Medicaid, transportation expenses

By Tim Hoover

Source: KCS
Credit: The Kansas City Star
Tuesday, October 4, 2005
Edition: METROPOLITAN, Section: METROPOLITAN, Page B1

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JEFFERSON CITY - The state of Missouri could save millions of dollars by properly bidding and monitoring Medicaid services for medical equipment and non-emergency transportation, according to an audit released Monday.

The report released by state Auditor Claire McCaskill followed an announcement last week by Attorney General Jay Nixon that his office had settled a fraud case against the company that has been providing non-emergency transportation for Medicaid recipients to places like doctors' offices and pharmacies.

In that case, Lake St. Louis-based Medical Transportation Management Inc. agreed to pay the state $2.4 million after Nixon's office alleged the company had overbilled or fraudulently billed the state for Medicaid clients' trips to medical providers.

The actions of McCaskill and Nixon, both Democrats, come at a time when a Republican-led commission of lawmakers is studying how to restructure the state's Medicaid program, which covers nearly 1 million people. The GOP-controlled legislature earlier this year eliminated Medicaid coverage for about 90,000 people, and much of the debate on the issue has centered on fraud by recipients.

McCaskill said Monday there is not enough emphasis on fraud by providers.

"The vast majority ... of Medicaid fraud that has been found has been ... perpetrated by providers, not by recipients," she said. "Frankly, I think it is tiresome to most Missourians to continue to have this rhetoric that the Medicaid problem should be borne on the backs of recipients."

Deborah Scott, a spokeswoman for the Department of Social Services, said the agency does not give any more weight to fraud by providers than it does to fraud by recipients.

"We have always viewed the issue of waste, fraud and abuse from both ends of the spectrum," Scott said.

Though McCaskill's audit examined practices that occurred under Democratic Gov. Bob Holden's administration, she said Republican Gov. Matt Blunt's administration has not corrected some of the problems she pointed out.

McCaskill's audit examined a 15-month period ending in March of 2004 in which the state paid Medical Transportation Management $44.1 million, of which at least $19 million was gross profit. The audit said the state did not properly monitor the contract with the company to determine whether it was finding the most appropriate transportation at the lowest cost.

In fact, the report said, the contract with the company often gave it an incentive to use the most expensive mode of travel, obtaining taxi rides for Medicaid clients or encouraging recipients to drive themselves and be reimbursed for mileage. Those options frequently were not the cheapest for taxpayers, the audit noted.

In one case, the company reimbursed a client $3.60 for a 24-mile trip and then charged the state $98.44 for administrative services on the trip, the report said. During the 15-month period, the company made an 87 percent gross profit on mileage reimbursements, the report said.

The state has put the contract for medical transportation out for re-bid and has received seven bids, which officials are reviewing now.

The Department of Social Services last year put the contract out for re-bid, and the state awarded the contract to LogistiCare Solutions LLC of Atlanta. However, the state then voided the contract after Medical Transportation Management argued there were technical irregularities in the bidding process.

The state has been contracting with Medical Transportation Management on a month-to-month basis since then.

Carol Rosse, director of corporate marketing for the Lake St. Louis company, called the results of McCaskill's report erroneous because the audit was based on a time before the company was operating under a stricter contract.

The company "has done everything in its power to make the non-emergency medical transportation program more cost efficient," Rosse said.

McCaskill's report also said the contract did not have controls to ensure that the trips were for Medicaid-related purposes. For one three-month period, there were 14,500 transportation claims that had no corresponding Medicaid claims filed with the state, the report said.

The audit also said that the new contract proposal the state was developing could be flawed because it was based on "historically high" costs in previous contracts with Medical Transportation Management. Scott said the previous rates were just one factor in developing the new contract, and Commissioner of Administration Mike Keathley said there would be a substantial savings over previous contracts.

The audit also found that Missouri could save $5.4 million a year if it competitively bid its medical equipment services.

Missouri paid more than its eight surrounding states for 41 percent of the pieces of equipment reviewed in the audit. In one example, a prosthetic device that four other states paid $1,830 for cost Missouri $2,440.

The department is considering taking competitive bids on the equipment, Scott said.

To reach Tim Hoover, call 1-(573)-634-3565 or send e-mail to thoover@kcstar.com.

First glance

Though a recent report examined practices that occurred under Democratic Gov. Bob Holden's administration, she said Republican Gov. Matt Blunt's administration has not corrected some of the problems she pointed out.

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