Press Release  Auditor Bump Commends Cataldo for Implementing Changes, Urges More Improvements Needed

Boston — Auditor Suzanne M. Bump today issued an audit that found that MassHealth contractor Cataldo Ambulance Services improved its annual criminal offender record information (CORI) background check process for their drivers as a result of a 2014 audit by Bump’s office that led the Massachusetts Ambulance Association to alert their members of this requirement. Previously, they conducted these checks upon initial hire of an employee, but were inconsistent in performing the required annual checks.

“Proper background checks ensure that the health and safety of clients are protected,” Bump said of the findings. “Cataldo took quick and proactive steps to address our previous audit findings that showed that these background checks were not happening as they should, and they should be commended for making these improvements.”

However, the audit also found that the Somerville-based company received up to $942,326 in payments from MassHealth for wheelchair-van services that lacked properly completed Medical Necessity Forms (MNFs) In order for MassHealth to pay a claim for wheelchair-van transportation, it must be requested and documented with a MNF authorized by a physician, nurse, or nurse practitioner and retained by the transportation provider. The audit found that Cataldo’s documentation included signed forms by unauthorized individuals, illegible signatures, and missing titles of signatories. For every claim tested, however, the audit did find a corresponding medical claim for the member on the same date of transportation service, confirming that the transportation, while not properly authorized, was actually provided.

MassHealth acknowledged the documentation issues, and stated they intend, within six months, to review Cataldo’s documentation to ensure that they are in compliance with appropriate regulations.

“While our audit found no evidence that funds were improperly spent, correct documentation is critical to protect against potential fraudulent spending in the future,” Bump warned. “I’m pleased that MassHealth recognizes the importance of this issue and has committed to addressing it.”

MassHealth, the state’s Medicaid agency, contracts with private vendors to provide wheelchair-van transportation when it is medically necessary for its members. During the two year audit period, MassHealth paid a total of approximately $39.5 million for wheelchair-van transportation for 49,745 members. The Office of the State Auditor (OSA) used data analytics to review wheelchair-van transportation claims in the Medicaid Management Information System (MMIS) to identify the frequency and cost of services performed by providers of wheelchair-van transportation as well as billing anomalies that could indicate fraud, waste or abuse. Cataldo was identified as one of the top 10 providers of wheelchair-van transportation and thus was chosen for this audit. In October 2015, OSA conducted a similar audit of MassHealth wheelchair-van provider RiteWay, which found more than $16 million in potentially fraudulent charges for members who did not need or did not use wheelchairs.

MassHealth, the state’s Medicaid agency, paid health care providers more than $13.6 billion in fiscal year 2015 and provided healthcare services for approximately 1.9 million low-and-moderate income individuals. MassHealth is the state’s largest program and accounts for approximately one-third of the state budget.

The Cataldo Ambulance Services audit is available here.

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