The Department of Health Care Policy and Financing is pledging to resolve a number of issues stemming from a third-party company contracted to transport Medicaid recipients to their appointments.
A report from the Office of the State Auditor presented to a legislative oversight panel on Monday showed among other things that IntelliRide, a company contracted with the state to provide non-emergent medical transportation, fell short on a number of fronts and HCPF lacked the regulatory controls to catch those shortcomings.
IntelliRide was originally contracted to administer NEMT services for nine Front Range counties, before the state expanded the contract with the company in Fiscal Year 2021 to cover the entirety of the state at a cost of $2.9 million. HCPF subsequently paid out some $33.2 million for NEMT services during the audit period, which was conducted between July 2020 to Feb. 2021.
According to the report, auditors found HCPF paid out $291,600 for NEMT claims that did not comply with state and federal regulations as well as another $5.2 million for claims that were potentially noncompliant. Auditors estimated the federal government, which contributes funding to NEMT programs, could seek to recoup $146,000 for the noncompliant charges as well as an additional $2.5 million if those potentially noncompliant payments “are determined to have not been appropriate.”
Auditors also found a 20% gap between the 93% rate which IntelliRide said it provided on-time rides to clients and the 73% on-time rate found by auditors. The report found IntelliRide excluded no-shows and cancelled rides in its calculation. The report also found IntelliRide failed to answered calls to its hotlines in a timely manner and did not resolve and report complaints or incidents that risked the health and safety of the ride recipient.
“During the audit period, 68 percent of complaints filed with (IntelliRide) went unresolved, and 75 incidents that risked recipients’ health or safety were not investigated or reported to the Department,” a release from the state auditor’s office said.
Auditors also identified 32 instances of potential mistreatment of at-risk adults during NEMT rides, including several injuries detailed by auditors in the hearing. According to the audit, the HCPF did not report those incidents to law enforcement or Adult Protective Services, which is required under state law.
The report identified six recommendations for improvements, including tighter IT controls, more oversight on services and pay and required reporting of potential mistreatment of at-risk adults, something auditors said NEMT staff were not aware of and had not reported.
HCPF Executive Director Kim Bimestefer noted the NEMT contract the state had signed with IntelliRide is being scaled back starting this month, with the company returning to providing rides in the nine Front Range counties it originally served. Transportation providers will serve the state’s other 55 counties.
Bimestefer and her staff indicated HCPF agreed with each of the findings and pledged to implement the auditors’ recommendations by as early as December and no later than Dec. 2022. She noted NEMT program is “difficult to manage” and that IntelliRide launched statewide services as the COVID-19 pandemic struck Colorado. Bimestefer also said she would prefer to continue with IntelliRide when quizzed by committee Chair Dafna Michaelson Jenet, D-Commerce City, if it would be better to find a NEMT partner that “operates their business better.”
“Our preference... is to try to correct what we have, to take accountability where we have opportunity and to hold our vendor accountable,” Bimestefer said. “I'd like to spend more time fixing this rather than going through another transition and holding the vendor more financially accountable to make sure it's as important to them as it is to all of us.”