Columbia, S.C-- On the heels of a guilty plea on Tuesday, Feb. 27 of an Upstate transportation provider for making false Medicaid claims, the South Carolina Department of Health and Human Services wishes to applaud those who report suspected fraud and abuse in the system.
Forest Hunter Thomas, former owner of Northern Anderson County EMS, was ordered by a Richland County judge to pay DHHS $500,000 in restitution. Thomas stood accused of padding mileage and inappropriately billing Medicaid for more expensive transports than were actually warranted.
DHHS referred to case the state’s Attorney General’s Office in May 2006 after receiving an anonymous tip to its Medicaid Fraud and Abuse Hotline (1-888-364-3224). The agency strongly encourages both Medicaid service providers and recipients to report suspected wrongful use of Medicaid funds.
“We’re pleased that civic-minded individuals are taking the initiative to report suspicious provider activity,” said DHHS director Robert M. Kerr. “The Department of Health and Human Services takes these cases very seriously because providers who try to bilk the system are not only cheating taxpayers, but they are also hurting the sick and frail who depend on Medicaid services.”
The agency’s Division of Program Integrity is dedicated to pursuing any credible fraud or abuse lead. Last year, DHHS recovered more than $9.2 million in overpayments and excessive use of Medicaid benefits.
DHHS spent $53.4 million on emergency and non-emergency transportation in 2006 alone, more than a 12 percent increase from the previous year. Medicaid reimburses approved providers for both emergency and non-emergency transportation to and from doctors visits, hospitals and other care facilities.
Unfortunately, fraud, waste and abuse in Medicaid transportation are likely not limited to the Northern Anderson County EMS case and DHHS has recently uncovered numerous other instances of potential misuse, including:
· DHHS identified more than a dozen cases in which payment was sought for transport of Medicaid patients when there was no supporting medical claim to justify the trip. The cases were detected through a new DHHS data system partly designed to detect fraud and abuse.
· In December, a citizen reported a Medicaid transportation driver who used a state-authorized vehicle to purchase alcohol at a liquor store during work hours. Other drivers have been observed shopping at flea markets, sharing gasoline accounts with friends and engaging in other improper activities while on duty.
· Several other cases of potential transportation fraud referred by DHHS are currently under review by the state’s Attorney General’s Office.
DHHS will further reduce fraud in the future through its contracts with two independent transportation brokers that will provide enhanced quality controls to ensure Medicaid funds are used wisely. Among other functions, the brokers will track mileage of vehicles used for Medicaid transportation, verify medical appointments against transport logs and screen driver credentials.
For more information, please visit www.scdhhs.gov or call the Medicaid Fraud and Abuse Hotline at 1-888-364-3224.