Office of Medicaid (MassHealth)-Review of Wheelchair Van Services Claims Submitted by Cataldo Ambulance Service

This is a Massachusetts State Auditor performance audit of wheelchair-van service claims that Cataldo Ambulance Service submitted to MassHealth for trips provided from January 1, 2013 through December 31, 2014.

“The Office of the State Auditor (OSA) has conducted an audit of claims for wheelchair-van services provided to MassHealth members by Cataldo Ambulance Service, Inc. for the period January 1, 2013 through December 31, 2014.”

Auditors wanted to check whether Cataldo followed MassHealth rules when billing the state for wheelchair-van transportation.

“The purpose of this audit was to determine whether Cataldo submitted transportation claims to MassHealth in compliance with state regulations and MassHealth policies.”

MassHealth is a major public program, and these services are paid with public money, so weak documentation and driver-screening controls matter to taxpayers and patients.

“Medicaid expenditures represent approximately 38% of the Commonwealth’s total annual budget.”

If you use MassHealth, pay Massachusetts taxes, or care about vulnerable patients, this audit is about whether transportation providers document that trips are medically needed and whether drivers are properly checked.

“As a result of the missing CORI checks, Cataldo cannot be certain that employees with disqualifying criminal records do not have access to vulnerable MassHealth members, including those who are elderly, underage, and/or disabled.”

MassHealth said it would review Cataldo’s medical necessity forms and visit the company to check whether it had written policies and was doing required driver background checks.

“MassHealth intends, within 6 months of [OSA]’s final report, to conduct an on-site visit to ensure that Cataldo has established a formal written policy that requires annual CORI checks for all wheelchair-van drivers, to review Cataldo’s procedures, and to verify that CORI checks are being performed in accordance with Cataldo’s policy and MassHealth regulations.”

The audit did not say the trips were fake; it said many were not properly authorized, while auditors still found matching medical claims showing the transportation was actually provided.

“This confirmed to OSA that the transportation, although not properly authorized, was actually provided.”

A Medical Necessity Form is the paperwork showing that a wheelchair van is medically needed; CORI means a criminal background record check.

“The MNF must include the date of service; authorizing signature; authorization period (the period when a member can receive transportation, which cannot exceed 30 days without a review of medical records); the nature of the member’s condition that warrants this type of transportation rather than a less-costly form of transportation; and a description of the member’s specific medical condition.”