Latest news with #HCPF
Yahoo
28-02-2025
- Health
- Yahoo
Audit: Millions paid to deceased Medicaid members
(COLORADO) — An audit by the Office of the Inspector General (OIG) is reporting that approximately $6 million in payments were made to deceased recipients of Medicaid and care organizations, while the State of Colorado argues the audit is not accurate and it will not be paying back the the $6 million. According to the audit report, Colorado pays Medicaid managed care organizations (MCOs) for health care services provided to Medicaid enrollees; in return, MCOs receive a monthly fixed payment for each enrollee (capitation payment). The OIG said the audit was initiated due to previous audits revealing other states making improper payments on behalf of deceased enrollees. According to the OIG's findings, Colorado made capitation payments to MCOs on behalf of deceased enrollees: Of the 120 capitation payments in a random sample, 109 payments were made on behalf of deceased enrollees whose dates of death preceded the service period covered by the monthly capitation payment. Almost 39,000 unallowable capitation payments were made by the State of Colorado on behalf of deceased enrollees even though their dates of death were accurately recorded in the State's eligibility system. The OIG said it estimates Colorado made at least $3.8 million in unallowable capitation payments to MCOs on behalf of deceased enrollees. In addition, the OIG said Colorado incorrectly reported other Medicaid expenditures to the Centers for Medicare & Medicaid Services (CMS) totaling over $2.2 million. The OIG recommended that Colorado refund the estimated $6 million to the federal government. In a statement from the Colorado Department of Health Care Policy & Financing (HCPF), 'The Department of Health Care Policy & Financing (HCPF) has many control processes to verify that individuals have died and is constantly working to enhance these controls,' the Department said in its statement. 'HCPF disagrees with the OIG's assumption that all members in their sample were actually deceased when identified by the OIG.' HCPF went on to argue that the OIG used 'data analysis of questionable sources' and said it would be performing its own verification of the eligibility system, as the OIG did not independently perform outreach to deceased members' families to ensure the results were accurate. In addition, HCPF said it has sourced information to the OIG showing some cases were closed due to reasons other than death such as failure to respond, residency out of state, etc. 'HCPF does not plan to return the $6 million,' the Department went on to state. 'Based on the OIG's inadequate approach in reaching the financial estimates in this report, HCPF will need to spend time disputing the estimates directly with the Centers for Medicare, Medicaid Services (CMS), rather than attempting to identify and recover unallowable capitation payments made to our Managed Care Organizations solely based on the OIG report. If there was to be any kind of pay back, any final settlement with CMS will take 2-3 years to negotiate.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
22-02-2025
- Health
- Yahoo
MedRide granted temporary resumption of medical transport
(COLORADO) — A Denver District Court has granted a Temporary Restraining Order (TRO) filed by MedRide, allowing MedRide to resume providing Non-Emergent Medical Transportation (NEMT) services. The TRO became effective on Feb. 20 and allows MedRide to resume NEMT services for a 14-day period until March 6. MedRide shared a statement on its website, 'We are truly relieved to announce that a state court judge has granted MedRide the ability to resume service for all Health First Colorado patients, starting on February 21.' Andy Boian for MedRide said the company is confident it will continue service past March 6, filing with the court to continue past the 14-day deadline or get an extension of the TRO. Colorado Department of Health Care Policy & Financing (HCPF) is advising anyone who needs NEMT services after March 6 to be aware the TRO does not authorize MedRide to provide services after that date. If you need NEMT services after March 6, HCPF has a list of all NEMT providers on its website. Those in need of services can contact (800) 221-3943 to get help finding a NEMT provider in their area as well. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
12-02-2025
- Health
- Yahoo
Department of Health: MedRide contract terminated
(COLORADO) — On Monday, Feb. 10, the Department of Health Care Policy & Financing (HCPF) lifted its suspension with Non-Emergency Medical Transportation (NEMT) provider MedRide, and announced it would instead terminate the company's contract. The suspension was initially put in place on Jan. 31, 2025, after an initial review of MedRide found significant deficiencies in reimbursement paperwork, including missing member signatures, missing dates and times, and claims forms with missing information from poor scanning. PREVIOUS COVERAGE: State Medicaid suspends contract with MedRide According to a spokesperson with HCPF, NEMT providers must meet certain requirements to provide services in accordance with state and federal regulations. Reasons HCPF cited for terminating MedRide's contract include the company's failure to: Complete the required criminal background checks for more than 200 drivers Provide valid and current proof of insurance Ensure proper vehicle safety inspections and registrations for vehicles used to transport Health First Colorado members Submit claims with accurate and complete documentation. Additionally, HCPF said MedRide failed to comply with the Corrective Action Plan MedRide agreed to in November 2024. 'HCPF's top priority is the safety of Health First Colorado members. We are also focused on the sound stewardship of taxpayer dollars in administering our safety net coverage programs,' said HCPF Executive Director Kim Bimestefer. 'MedRide failed to comply with the program requirements that have been clearly communicated over the past year in order to achieve these critical priorities. More than 130 other NEMT providers have completed this process and are serving our members.' When FOX21 News reached out to MedRide for comment about the termination, the provider said, 'We have no documentation, no phone call, NOTHING to say it is [terminated].' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
07-02-2025
- Health
- Yahoo
State Medicaid suspends contract with MedRide
(COLORADO) — Colorado's Department of Health Care Policy & Financing (HCPF) said it has suspected MedRide's contract after it allegedly participated in a fraud scheme. According to HCPF, an initial review of MedRide found significant deficiencies in reimbursement paperwork, including missing member signatures, missing dates and times, and claims forms with missing information from poor scanning. In response to concerns by HCPF, a Corrective Action Plan was put in place that MedRide allegedly failed to comply with. The Corrective Action Plan required MedRide to hold a meeting in November with HCPF to certify that MedRide understood billing and documentation submission requirements. They also had to submit clean claims with the required supporting documentation for their reimbursements to be paid. The suspension is set to last for six months while HCPF investigates the alleged fraud, and HCPF may terminate or extend this six-month suspension or terminate MedRide as a provider as the investigation continues. MedRide is not allowed to provide services, and Medicaid members will need to find an alternate provider. Medicaid members who need assistance can contact the Member Contact Center at 1-(800) 221-3943. MedRide told FOX21 News it is working with HCPF to resume services and reiterated the suspension was temporary. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
