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.

bubble graphic

12

bubble graphic

Comments

  • the truth

    What people should be asking is why do we have this program at all? Why should we pay mileage for medicaid patients to go to the doctor? Does any insurance outside of medicaid have a program that pays you mileage to go to the doctor? I have worked around this program for years and can tell you it is corrupt and that local staff have agitated for years for change. The broker service will allow realtime view of the actual doctor billing to match with the travel dates. It should lower fraudulent billing and also remove this mountain of paperwork from local offices so they can focus on other work. This program is going from 20 million year to a projected 37 million due to Obama Care. It also causes hundreds of millions in unnecessary medical appointments as people are using it to make money. Hey lets go halfway across the state to doctor so we can make money off the mileage.

  • Hellbilly

    An earlier news report stated there were only three bidders- all from out of state. If that is true then you all look mighty foolish. Govt should use private firms to manage things like this instead of hiring a bunch of state workers.

  • RTT

    Our goverment complains that companies are sending jobs overseas. Isn't that the same thing as sending jobs to another state. What a waste of tax payers dollars. DHHR what a joke.

  • northforkfisher

    This will end up just like the private ambulance service Grant County got into. The service ended up paying 4 million back to medicaid because they were charging the wrong rates. When the dust settled, Grant County had to hire back all the crews they laid off and take back over the service.

  • John

    Save a million dollars lost to fraud, and then pay this out of state company two million dollars to oversee the program. Now that makes a lot of sense, but come to think of it, not much that comes out of Charleston makes any sense. I guess there was no company here in the state that could provide this service and keep the jobs here instead of giving them away to an out of state company. Very typical of the ones in control. Common sense does not prevail very much in this day and time.

  • Dave

    Im glad to see they went with an out-of-state vendor. Lets ship more WV jobs out of state. Stupid.

  • DWL

    With this idea, they've hired a thief to watch other thieves. Easiest way to reduce fraud in the Medicaid program is to eliminate DHHR.

  • sam

    this is really a stupid idea.

  • steve davis

    What have you been smoking RH? In what universe is the government more efficient and less prone to waste and corruption than the private sector? Your numbers must come from the accounting firm that handled Madoff's investments.

  • RHytonen

    Since when has ANY function been SAVED money by privatization?
    Studies have proven that, at a minimum, privatizing anything DOUBLES COSTS to the taxpayer by adding layers of profit, management, and corruption.
    The increase is much larger in any medical area, where procedures in other countries cost as much as a TENTH that in America, with statistically proven better results (W.H.O. statistics) and higher quality facilities reported by "medical tourists" seeking better and less expensive care- even including transportation.
    It's actually privatization that has destroyed our economy, in almost every area- such as defense, energy, banking, prisons, health care - and corrupted our government.

  • Hellbilly

    JM- What type of complaints do you want them to act on? This is a democracy. Be constructive.

  • jm

    DHHR stopping fraud........now that is fraudulent............ Why don't they act on complaints? that would be what they need to do..............