State’s Medicaid transport system gives contractor an upper hand

Nov 17, 2017
The Atlanta Journal-Constitution
LogistiCare runs a call center south of the airport, where staffers arrange, assign and schedule rides after verifying that patients qualify and that all rides are for medical needs. JOHNNY EDWARDS / JREDWARDS@AJC.COM

Medicaid patients who don’t have transportation can get free rides to dialysis, checkups, rehabilitation, pharmacies and other medical visits. That’s because the federal government wants to keep them out of emergency rooms and keep overall health care costs low.

To run those non-emergency medical transportation programs, states have the option to use contractors, known as brokers. Georgia has taken that route since 1997.

Georgia pays LogistiCare, its biggest contractor, based on the number of Medicaid patients in its regions who are eligible for the free rides, rather than on the number of rides. Its current contract, which started in 2012, covers more than 830,000 people in the southside of metro Atlanta, in most of the state’s mid-sized cities and in its rural areas. For its work, LogistiCare was paid about $56 million in 2015 and almost $58 million last year, Georgia records show.

LogistiCare uses a portion of the state funds to pay those who provide the driving and interact with patients: some 129 subcontracting transport providers throughout the state, along with about 180 “volunteer drivers” and an occasional Lyft or cab company.

LogistiCare has an incentive for keeping those payments as low as possible: It keeps excess money.

It has other expenses as well, though. The company runs a call center south of the airport, whose staff arranges, assigns and schedules rides after verifying that patients qualify and that all rides are for medical needs. It is also responsible for ensuring that transportation providers use vehicles that meet state requirements, that drivers are licensed and qualified and that improper payments are prevented.

The company presents the state with a glowing picture of its work. The company’s latest customer service satisfaction survey, which it provided to the AJC, shows an overall satisfaction rate of 92 percent. The survey sampled 603 patients over the phone, asking them to respond to 77 questions.

In addition, in bid documents the company claims a complaint rate of less than 1 percent. “We respond to all complaints that we receive,” LogistiCare Executive Vice President Steve Linowes said.

Such claims have been called into question in some other states. A Connecticut audit in 2014 found the company might be underreporting complaints. LogistiCare disputes that.

In Wisconsin, a newspaper reported in 2012 that the company wasn’t logging all complaints. In New Jersey, a 2016 survey by a mental health association found 36 percent of a sample of mental health patients said they either filed a complaint or tried to file one but couldn’t.

The AJC found two instances of Georgia taking action over LogistiCare’s complaint records. Site visits in 2015 and 2016 found the company lacking documentation that its staffers responded to people lodging complaints within the required 24 hours, according to correspondence between the state and the company.

LogistiCare paid a total $21,000 in fines for those infractions.