CHARLESTON, W.Va. – The state DHHR hopes to save at least a few million dollars a year by hiring a broker to handle non-emergency medical transport services for state residents under Medicaid.
The DHHR announced last week the hiring of St. Louis-based Medical Transportation Management.
DHHR Deputy Secretary Jeremiah Samples said MTM will coordinate the federally mandated non-emergency transports in hopes of uncovering current fraud in the system. The program is currently managed by county DHHR offices.
“We need a vendor who can assist us from the private sector. In essence, clamping down on some of the abuse that we feel may exist in this program,” Samples said.
In 2013, there were more than 432,000 non-emergency transports in West Virginia for residents under Medicaid. Samples said most of them were friends and family members taking those residents for doctor visits, but he said, not all of those doing the driving should be reimbursed.
“Sometimes these vehicles aren’t licensed. Sometimes those doing the driving aren’t insured,” Samples said. “We do recognize there is potential for a lot of fraud out there and as other states have implemented these types of contracts they’ve saved several millions of dollars.”
When the original bids for a broker were put out last year the broker was also to be in charge of choosing ambulance services that do non-emergency transports. Those services expressed concern about the change so in a second bidding the DHHR removed stretcher transports from the broker system. So if a person is taken by ambulance on a stretcher for a non-emergency transport it will not be managed by the broker.
Samples said states similar to West Virginia like Mississippi and Delaware have saved millions of dollars a year by going with a broker. He believes that same potential exists in West Virginia.
MTM will also have to perform. Samples said the DHHR can cut the contract after a year.
“We’re really holding our vendors accountable,” he said. “We’re going to be looking intensely at all of our contracts. We want to retain the ability to put something out to bid if this vendor comes in and is not able to deliver.”
Samples said the goal of the broker program and others under Medicaid is to operate the multimillion dollar system more efficiently.
“This is all part of our effort to crack down on fraud, crack down on abuse of the system and really streamline Medicaid and transform it into a public insurance model, more of what you’d find on the commercial side as opposed to how it’s been managed historically.”
MTM will begin its work in West Virginia on June 1 with full broker services scheduled to start this fall.