“The actual over-payment amount is only $13,000,” she said. “And what they do is multiply that times five. They take whatever findings there are and act like they overpaid you $72,000… And the other interesting thing was they said ‘at this point, now we can no longer put the clients’ names,’ so I have no way of double checking.”
State Auditor David Yost sent out a press release on Oct. 20 saying Fairfield-based Universal Transportation Systems, LLC employed eight drivers with lapses in first aid and/or CPR certification and billed for transports that were not covered by the Medicaid program or for transports that did not occur, according to the audit.
Yost’s spokeswoman Brittany Halpin explained the data the auditors examined was only a sampling of the total trips that occurred between January 2010 and December on 2012.
“This is what we do oftentimes when we do audits of these transportation companies and service providers,” she said. “This is something Medicaid allows for. We do a statistical sample, and then we are able to project the total finding based on the number of errors in the sample. Then, that goes to a data analyst who does the analysis that the projected findings are sound.”
Burer disagreed with the “sampling” characterization.
“It wasn’t a sample, they keep acting like they did some sampling,” she said. “They checked every trip for that three-year span.”
The audit report showed UTS was paid $179,643 in reimbursement for 12,697 ambulette services. Carrie Bartunek, the communications director for the auditor, said Burer had to provide all the records, but the auditors only looked at a sample.
“We never go into an entity and look at every single record, we couldn’t do that financially or time-wise,” Bartunek said. “We don’t have that kind of resource nor would we charge someone to look at every single record. That is not the way auditing is done, auditing is done by sample.”
Auditors reviewed 2,564 ambulette transports — 1,275 transports and 1,289 mileage codes — UTS provided and found missing or incomplete paperwork to authorize the wheelchair transports and other errors including:
• 72 transports where the recipients were not transported to a Medicaid covered service, or due to incomplete trip documentation, it could not be determined that the transport was to a Medicaid covered service;
• Nine transports with no service documentation;
• Five transports where the service documentation was marked “no show”;
• Three transports where the service documentation was marked “cancelled,” but the required documentation was not provided
The auditor also reviewed the personnel files for 11 drivers and eight of them had lapsed in first aid and/or CPR training, ranging from approximately 10 days to 7 months. These drivers were ineligible to provide services during the periods of the lapses.
Burer admits there may have been a couple times drivers were late in getting their training. But she said the auditors counted trips twice, once for the flat rate and again for the mileage to arrive at the number of errors and the money owed, which she said is wrong.
“It makes this look like fraud and horrible things,” she said.
UTS won contracts with Job and Family Services and the Butler County Veterans Service Commission last year for $10 million and $263,628 respectively. JFS Director Jerome Kearns told the Journal-News his agency has never contracted for ambulette service with UTS so the county wouldn’t have been involved in the audit. Burer said the vet board rides don’t involve Medicaid.
Burer said she has been in contact with JFS.
“I did call Jobs and Family and the only thing I knew to say is they are welcome to come in any day and pull the drawer open and just pull anything they want out,” she said. “At random, any day, any of the records.”
UTS attorney Chris Jenkins said a couple of things have to happen before they can appeal. The Medicaid office must accept the auditor’s report and issue a payment order to UTS first. He says it appears they have good grounds to appeal.
“It appears that there may be a basis for an appeal if an order consistent with the recommendation is issued. Among other things, it appears that all of the trips performed were analyzed and potential violations totaling in the range of approximately $13,000 were found,” Jenkins wrote in an email. “But even though all trips were analyzed, it appears that the auditor still extrapolated to make a theoretical finding for much more.”
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