The Medicaid Transportation Billing Scandal
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Soon after Governor Charlie Baker's administration came into office in January of
2014 many state agencies underwent extensive budget audits including one involving
Medicaid benefits paid to state contract vendors administered through MassHealth for
non-emergency medical transportation services. Those audits conducted by the Office of
the State Auditor (OSA) targeted a single vendor (Rite Way LLC) whose billing practices
were the most egregious. Those audits also resulted in a dramatic reduction in monthly
payments made to other, similar vendors, from whom sufficient claims records (in Rite
Way LLC's particular case PT-l forms or MNFs, so-called Medical Necessity Forms),
and other proof-of-service documentation, was lacking.
Please Google: Office of the State Auditor (OSA) - Annual Report: Medicaid
Audit Unit [from] March 14, 2015 - March 15, 2016, issued March 15, 2016; as
well as the: OSA's Office of Medicaid (MassHealth) - Claims for Wheelchair Van
Services Submitted by Rite Way LLC: Official Audit Report - Issued
October 5, 2015 (Audit No. 2015-1374-3M9). See also: State Auditor Suzzanne
M. Bump's press release dated October 5, 2015 "Audit Finds More Than $16
Million in Potentially Fraudulent Billings from MassHea1th Vendor"; and Boston
Globe article by Felicia J. Freyer dated October 5,2015 "Company billed $16m
for unnecessary van rides, auditor says."
During that audit period between September of 2014 and February of 2015,
GATRA reduced its Medicaid payments to Plimoth Transportation from approximately
$31,300 to approximately $17,300 a month, a reduction of approximately forty-five
(45%) percent (That 6 month period is readily available to the public on GATRA's
website: Open Government>>Open Checkbook function, but erroneously lists the dates
as being 07/31/14 through 12/31/14). It may never be known for certain whether
GATRA's actions resulted from billing irregularities by Plimoth Transportation, but the
timing and facts speak for themselves.
Meanwhile, during that same period of time, from July 31, 2014 through February
28, 2015, Plimoth Transportation had gradually escalated its monthly billing through
CCRTA from $11,193.00 to $23,830.99, an increase of more than one hundred (100%+)
percent.
Retirees, the poor and those living on fixed incomes who are dependent on
Medicaid and MassHealth face a future of uncertainty, as those government benefits
remain under constant threat of budget cuts and insolvency, in part due to corruption,
fraud and abuse. The legislative intent behind the creation of both Medicaid and
MassHealth was to help the needy, not Scott Vecchi.
Perhaps the State Auditor's Office should take a closer look at the billing
practices and Medicaid/MassHealth payments made to Plimoth Transportation, as it did
with Right Way LLC, and if appropriate, seek restitution of any monies that might have
been wrongfully paid for transportation services that can not be properly documented.
During the past six (6) years, Scott Vecchi, through his business, Plimoth
Transportation, has profiteered from the heroin and opioid epidemic to the tune of more
than two and a third million dollars. As a law-enforcement officer and alleged "public
servant" that is not a bad take, particularly for a seif-proclaimed crusader, fighting the
scourge of substance abuse.
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