FWA Insights: Identifying non-emergency transportation billing risks

Cotiviti Blog · 5 hrs ago · 10 views

Non-emergency transportation is an essential function that helps Medicaid members access necessary care when they cannot safely use standard transportation. But because these services involve multiple billing components like vehicle type, mileage, and wait time, they can also create vulnerabilities when utilization appears unusually high or inconsistent with policy limits. Recent public attention around transportation-related Medicaid fraud, waste, and abuse (FWA) in Minnesota has reinforced the need for health plans to assess whether exposure may exist in other markets, particularly given complex reimbursement rules that potentially make these services more vulnerable to bad actors. In this edition of FWA Insights, we explore how special investigative units (SIUs) can take a proactive, data-driven approach to identifying potential FWA in non-emergency transportation claims.  

Non-emergency transportation is an essential function that helps Medicaid members access necessary care when they cannot safely use standard transportation. But because these services involve multiple billing components like vehicle type, mileage, and wait time, they can also create vulnerabilities when utilization appears unusually high or inconsistent with policy limits.

Recent public attention around transportation-related Medicaid fraud, waste, and abuse (FWA) in Minnesota has reinforced the need for health plans to assess whether exposure may exist in other markets, particularly given complex reimbursement rules that potentially make these services more vulnerable to bad actors.

In this edition of FWA Insights, we explore how special investigative units (SIUs) can take a proactive, data-driven approach to identifying potential FWA in non-emergency transportation claims.