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Rhode Island asked to refund $4.9M

Healthcare Auditing Weekly, April 1, 2008

The OIG wants the Rhode Island Medicaid agency to refund $4.9 million for Medicaid non-emergency transportation (NET) costs, according to an OIG audit.

The audit found the agency's purchase of monthly bus passes instead of 10-ride bus passes from March 2004 through May 2005 was not cost efficient. The agency did not consider utilization data in determining whether monthly bus passes were cost-effective, according to the OIG. The state agency's claim also included bus passes for two non-Medicaid programs.

The OIG recommended the state agency:

• Refund $4.9 million for NET costs claimed for monthly bus passes or show the monthly bus passes were the most cost-effective means of providing NET
• Refund $193,226 in unallowable NET costs claimed for beneficiaries of two non-Medicaid state programs
• Review NET costs for bus passes reimbursed after the audit period
• Recalculate the state agency's claim based on Medicaid beneficiaries' use of medical services and the purchase of 10-ride bus passes
• Refund NET costs reimbursed in excess of the recalculated amount
• Establish policies and procedures, including utilization reviews, to ensure it complies with federal requirements and the state plan for claiming NET costs that are reasonable, allocable, and cost effective

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