Frew and Medical Transportation on a Collision Course

On May 28^th, 2009, Appropriations Committee Chairman Jim Pitts, R-Waxahachie, was laying out the appropriations bill at the end of legislative session. Rep. Warren Chisum, R-Pampa, a senior and respected member of the Texas House, stands at the back microphone and inquires about Rider 55 -- the broker pilot amendment. Part of the actual conversation is embedded in this Rep. Senfronia Thompson’s Attorney General request. See Report Here.

What kind of impact will this rider have on the Frew lawsuit and the settlement agreement? None, that he knows of, Pitts replies. Are you sure? Chisum is unconvinced. Pitts maintains the state has nothing to fear. Chisum walks away from the back microphone and says, “I guess we’ll see.”

Fast forward to the Medical Transportation Program public hearing, October 29, 2012 – nearly eight months after the broker pilots became operational. The public hearing is populated with transit folks, brokers and many, many employees from HHSC.

A transit representative stands and asks the question: “Who from HHSC is monitoring whether the brokers in the pilot regions are complying with the Frew lawsuit settlement agreement?”

Silence. Not sure. We’ll get back to you. A good indication that no one is watching. If no one is watching and the brokers are self-reporting without much oversight, then “Frew – The Sequel” should be in the State’s foreseeable future.

Frew vs. Hawkins  -- this class action lawsuit was originally filed in 1993 and alleged numerous, serious failings in the State's efforts to ensure all children already enrolled in Medicaid were receiving appropriate preventive and specialty care services available to them through the federally-required Early Periodic Screening Diagnosis and Treatment Act (EPSDT). Access and therefore medical transportation was a major component of the suit, the settlement agreement, the consent decree and the corrective action plans. A brief history of the Frew lawsuit can be found here: History of Frew Lawsuit

It took 14 years for Frew to wind its way through the legal labyrinth culminating in Texas coughing up $707 million in general revenue in 2007. The Frew Version #1 was the result of benign neglect not a nefarious plot to deny children their medical care. But full-risk brokers use various time-honored techniques to discourage rides and therefore deny access, like long hold times or being discourteous to clients. Policymakers have been warned repeatedly about brokers and their methods.

The next trip to the courthouse will not take 14 years because everyone (no exaggeration here – everyone) involved has been duly informed and warned. In fact, here is a letter to the Texas House Committee on Transportation by Susan Zinn, the plaintiff attorney on Frew. Ms. Zinn offers one suggestion to the committee; let the broker model “die a peaceful death.” See Zinn Letter 8/17//10

Some interesting points:

• Logisticare has reported about 6000 complaints in 7 months. It is reasonable to assume some of these complaints involve children. See Fox News Video here

• Brazos Transit District, the MTP provider in Bryan / College Station area, had 5 complaints. Two of those complaints involved incidents where the driver arrived TOO EARLY.

• STAR Transit, a MTP subcontractor to Logisticare, is reporting an 80% reduction in providing rides to children over the previous year (calculated month to month).

Brokers claim their program is all about managing risk. In short order, we feel the broker model will have lawmakers reaching for their wallets (well – taxpayer money) once an enterprising attorney figures it out.

What Are the Real Savings Numbers for Brokers?

Surprise Answer from HHSC!!!!

The broker model appropriations rider – the now infamous Rider 55 – was inserted in the Texas appropriations bill in 2009. The broker lobby had at least one compelling argument at the time: if the full-risk model was implemented statewide the state would enjoy a higher federal/state match rate: 60 – 40 from 50 -50 (only four regions at the time qualified for a 60 – 40 match according to the Center for Medicare and Medicaid (CMS). In a state hard pressed for cash the increased federal match was quite an inducement.

What would be the estimated gain to the state – financially speaking – if the whole state turned broker? This question and many other interesting questions were posed by the Rep. Joe Pickett, D-El Paso, then Chairman of the House Committee on Transportation to HHSC. The formal HHSCresponse is posted here.

The verdict? If HHSC went to a statewide full-risk broker and received the 60 – 40 match the additional federal yearly benefit -- $6 million. That’s $6 million as part of a nearly $200 million MTP program that in turn is part of a $12 billion Medicaid program.

But money is money right? Correct. In the final analysis, efforts should be made to achieve savings irrespective of the amount.

So in October of 2010 Rep. Ryan Guillen, D-Rio Grande City worked with transportation consultant David Raphael, and HHSC to submit a 1915b Medicaid waiver to CMS. That waiver allowed Texas to obtain the higher 60 – 40 match WITHOUT moving to a statewide broker system. Here’s a copy of the waiver.

That waiver was awarded by CMS to Texas on April 1, 2011 (ironically as anti-broker factions beat back another attempt to on the House floor to expand the broker model.) Most likely the waiver was awarded on the strength of the existing transportation networks in Texas.

Texas has been receiving the higher match since then.

So savings to Texas by full implementation of the broker model?

Zero.

Next: Frew Lawsuit Redux: Broker Pied Piper Trek to Yet Another Lawsuit (this time it won’t take 14 years)

Medical Transportation Fraud

Broker Stalking Horse

There are conversations floating around the Texas capitol pointing to fraud with the medical transportation program. Some cite the HHSC March 2012 internal audit report as evidence that MTP needs a complete overhaul. The broker lobby claims they can end fraud once and for all if the state moves to a statewide broker system. You can find the HHSC audit report here.

While the report found some fraud, waste and abuse none of it pertained to public transit agencies.

We interviewed a former HHSC executive who agreed to talk to us under the condition of anonymity. He says, “The audit was more about us (HHSC) than anything else. The fraud elements related to an incident in one of our call centers in San Antonio and problems with advanced payments and ITPs (Independent Transportation Providers.) We (HHSC) need to monitor that part of MTP better but public transportation came out clean.”

And just for the record (and because we’re curious), what do you think of the full-risk broker model?

“Snake oil, “ he says. “Pure and simple.”

Brokers will wave the banner of fraud to convince policymakers to hand them the keys to the Medicaid car by lumping the problems of ITP and advanced payment with the larger part of the program which includes public transportation and qualified private providers.

Law to Regulate Broker Subcontractors Never Fully Implemented

Last Session: HB 2136 Update
Law to Regulate Broker Subcontractors Never Fully Implemented

Last session HB 2136 was authored by two-time recipient of the Texas Transit Association Legislator of the Year Award, Rep. Ryan Guillen and sponsor

ed by one-time Legislator of the Year recipient Sen. Judith Zaffirini. HB 2136 was intended to regulate subcontractors of full-risk brokers to ensure that subcontractors have the proper background checks, licensing, training and vehicle safety /maintenance standards. Here is the link to the bill: http://www.capitol.state.tx.us/tlodocs/82R/billtext/pdf/HB02136F.pdf#navpanes=0

So how is that going so far? So far, not much. First, the Texas Health and Human Services Commission (HHSC) was required by law to provide a training program and promulgate rules by Aug., 2013. Neither has been done to date, and with the impending legislative session kicking off in January, 2013, it is unlikely HHSC will get around to it any time soon.

What has been the result? Testimony given at the recent statewide public hearings
http://www.hhsc.state.tx.us/medicaid/index.html revealed that the brokers continue to contract with just about anyone. Apparently there are two critical criteria to be a subcontractor of a broker: 1. Have a pulse; and 2. Have a vehicle. Here are some tidbits that revealed at the public hearings:

• One women testified her mother was driven for 5 months by the same driver until it was “finally” discovered he was a registered sex offender.

• One women testified the van did not have the proper tie downs for a wheel chair and her husband was being tossed around the van during the trip.

• Another testified that after she complained to the broker that the vans were not ADA compliant, she was told that “ADA did not apply to the private sector.”

• Another revealed the driver drove down the wrong way down a highway while on a cell phone.

• One woman complained about the trash in the van – especially grotesque because it was the SAME trash week after week.

On and on…..

It’s time to enforce HB 2136 without delay.

To sign the TAPS Online Petition on MTP Options click on this link.

Petition to Oppose the Full-Broker Option

As a citizen with an interest in providing quality service for my tax dollars, I am asking you to please review your position on an important issue. The State of Texas Health and Human Services Commission Medical Transportation Program is currently seeking input on how it will continue to contract Non-Emergency Medical Transportation for Medicaid clients. Since summer, HHSC MTP has been using a "Full-Risk Broker" model that has already generated in excess of 6,000 service complaints. However, HHSC is considering continuing this seriously flawed model. As a supporter of local and community-based transportation providers, I believe that HHSC model options 3 (TSAP Enhancement) and 4 (Regional Transportation Partnership) offer better service and a better use of taxpayer funds.

Taps Starts Online Petition on MPT Options

If you are a Medicaid client who depends on public transportation, this issue concerns you.
What can you do, as a Medicaid recipient or interested party?
At this very moment, state officials are considering how non-emergency medical Medicaid trips are going to be delivered to clients. And we believe the model the commission prefers is a flawed one.
If you, or anyone you know, uses public transportation to get to Medicaid medical appointments, you need to know the facts.
Through a series of public meetings, the Texas State Health and Human Services Commission’s Medical Transportation Program, is outlining five models.
The current model —Full-Risk Broker— in place since July of this year, cut 75% of funding to TAPS and denied it the opportunity to provide local service to Medicaid clients in its own communities.
TAPS Public Transit supports model options (3) and (4) as being presented by HHSC. (Learn more here.)

MEDICAID NON-EMERGENCY MEDICAL TRANSPORTATION

no	MODEL	SUPPORT?
1	Full-Risk Broker Expansion	NO
2	Managed Care Carve-in	NO
3	Transportation Service Area Provider Enhancement	YES
4	Regional Transportation Partnership	YES
5	Hybrid Model	NO

What’s wrong with the Full-Risk Broker model?
A change in how your Medicaid Non-Emergency Medical trip, is assigned and paid for, has sidestepped local government and community supported transit agencies —like TAPS Public Transit, a regional provider— that have delivered superior service to Medicaid clients for the past 26 years.
Since summer, contracts with brokers like LogistiCare (a public company) and Irving Holdings LLC (a privately-held company), has led to a serious decline in the quality of service to Medicaid clients. These companies’ prime motivation is profits over service.
Nearly 7,000 complaints filed in the Dallas area alone

You may have seen the investigative news reports on the Dallas-area television station KDFX Fox 4 News, or read about the controversy in the newspapers that focuses on LogistiCare, a full-risk broker covering the Dallas and Fort Worth area. A lot of people are very upset about changes made to how trips are assigned to clients. And there has been a series of hearings to find out exactly what is going on, and what can be done to fix the many problems that have developed.

Get Rich Quick! Medical Transportation Opportunities

Get Rich Quick! Medical Transportation Opportunities

So where do the full-risk brokers find their transportation contractors. You know….the ones which are not regulated, ill-trained, and operating vehicles with intentional disregard for th

e Ame
ricans with Disabilities Act (ADA). The ones who don’t secure wheel chairs. The ones who may have a criminal record. The ones that may not even have a valid drivers license.

Well, NEMT is the new entrepreneurial business opportunity to get rich quick from tax dollars!

Here is what they are saying!

“Medicaid/Brokers:
Talk about FREE healthcare?! Medicaid recipients not only receive FREE medical benefits but, according to Article 1915 of the Social Security Act, recipients also get FREE transportation to and from their medical appointments!
But the good news for you, the transportation provider, is that with Medicaid, depending on your State, you can generate some seriously BIG reimbursement checks that you'll love receiving in the mail…like clockwork!
And similar to Private-Pay transportation providers, there are some NEMT providers that ONLY service Medicaid clients! Why? Because in some counties, the reimbursement rates are just that high!”

Wisconsin Update!!!

Logisticare-still-short-of-standard-despite-shorter-hold-times-

LogistiCare still short of standard despite shorter hold times

Wisconsin Update!!!
Calls down, hold times up – Anomaly or Corporate Strategy?

Full-risk broker contracts typically work like this: Broker is paid up front for all eligible Medicaid transportation users in a region. That region can be an entire state. Brokers are paid whether the rides are performed or not. Brokers are paid the same whether they broker one ride or one thousand rides.

You a broker and need to pad your bottom line? Problem solved! Discourage ridership by being late or have long hold times when a client calls. The client gets discouraged and quits (they hope).

The Milwaukee – Wisconsin Journal – Sentinel is reporting Logisticare is STILL having problems in spite of heightened legislative scrutiny. The Journal Sentinal reports

“The company's $38 million annual contract states that the average daily hold times can't be longer than two minutes on both lines combined. According to a Journal Sentinel analysis, LogistiCare has met that standard 32% of the time since Sept. 1, and on only three weekdays.”

"People are potentially not accessing their health care," Sen. Lena Taylor (D-Milwaukee) said in an interview. "That is concerning because this is preventive efforts and keeping up with appointments is so important to avoid those high emergency costs and loss of life.”

Broker Logisticare Under investigation In Missouri

kctv5-investigates-transport-troubles

Broker Logisticare Under investigation In Missouri
Republican State Representative Says the State Must Deal With the Issue

Many transportation observers feel that Missouri is the most full-risk broker friendly state in the country. So when

elected officials called for an investigation of broker Logisticare for poor service it must really be bad.

KCTV5 submitted a Missouri Open-Records request to confirm numerous reports of shoddy service. In a three month period, the records from Missouri HealthNet show that 783 complaints were filed against the state Medicaid transportation program.
The list of grievances includes 212 driver no-shows. There were at least 20 missed dialysis appointments, which led to the hospitalization of two patients.

Missouri Rep. Keith Frederick, R-Rolla, said the state must deal with the issue.
"You know we're talking pretty significant numbers of patients. It seems to me that rises to the level of requiring some type of response from our department," said Frederick, a member of the Missouri Health-Net Oversight Committee.
"If the contractor (Logisticare), the company that's been asked to do this, is really not doing their job, well then you know it's our job to see that they do that job or replace them," he said.

Option 5: Hybrid Model

For this option, NEMT services would be provided by either the full-risk broker or the managed care carve-in models described in options 1 and 2 and would require either entity to subcontract an agreed upon percentage of services through local transit authorities. This arrangement would allow the local transit authorities to continue providing service for MTP clients, especially in rural areas of the state.

Option 4: Regional Transportation Partnership

This option establishes a pilot regional public brokerage program in specific areas of the state for three years with three cooperating public transit districts – Brazos Transit, Capital Area Rural Transportation Services (CARTS) and Hill Country Transit (TSAPs 13, 12, and 23 respectively). The three transit districts would form a consortium to provi

de seamless and coordinated services to MTP clients in the 24-county region. In the remaining areas of the state, HHSC would have to pursue an alternate transportation model. Under an inter-local agreement with MTP, the consortium would assure dependable, economical and safe access to healthcare services throughout the region and, when necessary, to distant destinations. By coordinating inter-district travel, public, healthcare and other special purpose trips and taking advantage of lower cost fixed-route bus services within the region, the regional public broker would be able to reduce waste and duplication and substantially lower per trip costs while enhancing mobility and access for the Medicaid population.

Option 4: Regional Transportation Partnership

This option establishes a pilot regional public brokerage program in specific areas of the state for three years with three cooperating public transit districts – Brazos Transit, Capital Area Rural Transportation Services (CARTS) and Hill Country Transit (TSAPs 13, 12, and 23 respectively). The three transit districts would form a consortium to provi

de seamless and coordinated services to MTP clients in the 24-county region. In the remaining areas of the state, HHSC would have to pursue an alternate transportation model. Under an inter-local agreement with MTP, the consortium would assure dependable, economical and safe access to healthcare services throughout the region and, when necessary, to distant destinations. By coordinating inter-district travel, public, healthcare and other special purpose trips and taking advantage of lower cost fixed-route bus services within the region, the regional public broker would be able to reduce waste and duplication and substantially lower per trip costs while enhancing mobility and access for the Medicaid population.

Option 3: Transportation Service Area Provider (TSAP) Enhancement

This model maintains the existing transportation service structure, but enhances certain administrative functions, and delays the agency’s decision regarding a revised statewide service delivery plan. This option would extend the current TSAP model through June, 2015. The extension would allow time to collect adequate data for evaluation purposes and also aligns TSAP contract expiration with the expiration period for FRB contracts. Additionally, as a part of this model HHSC MTP call center operations would be outsourced.

Option 2: Managed Care Carve-in

This option proposes to carve-in NEMT services into managed care; however, in the Dallas/Fort Worth and Houston/Beaumont SDAs, the FRBs would continue to provide services until contract expiration. Since NEMT services are provided to TCIP, CSHCN, and residual fee-for-service clients who are not served by managed care organizations, HHSC will need a complimentary model to serve non-managed care clients. The non-managed care transportation services may be provided by a down-sized state operation or through a single FRB.

Option 1: Full-Risk Broker Expansion

HHSC successfully implemented two full-risk broker (FRB) models in the Houston/Beaumont and Dallas/FortWorth Service Delivery Areas (SDAs). This option would expand the FRB model to the remaining areas of the state not currently covered by the FRBs, roughly splitting statewide transportation services between one or more FRB contractors. The FRBs would be responsible for management of all nonemergency medical transportation (NEMT) services to include managed care clients, fee-for-service residual clients, Children with Special Healthcare Needs (CSHCN) Services Program clients, and Transportation for Indigent Cancer Patient (TICP) clients.

VERY IMPORTANT:

Yesterday in San Antonio Dimitria Pope again asked that any revisions to the proposals be submitted by November 15th. We need your regional plans/outlines in order to put them into a revised proposal.

Additionally, some people have asked that I summarize the options again. I have listed them separately in the next posts.

Our last forum is tomorrow, Wednesday, November 14th from 2:00pm - 5:00pm at the Commissioners Courtroom, 200 S. Texas Ave, Suite 106, Bryan, Texas.

John McBeth, Carole Warlick, Dave Marsh and several others have been working very hard to make this final a forum a success. We hope to bolster all that has been said over the last two weeks and present a final summary of our Option 4, as presented in our white paper.

Former bus district executive director faces 14 charges

Broker Executive Cindy Howe Indicted

After Logisticare was awarded the MTP contract in the Dallas area and the ink was dry on the contract with HHSC, the public transit industry was introduced to employee Cindy Howe.

Ms. Howe’s job was

to make Texas public transit agencies feel good about contracting with a full-risk broker because she “came” from the public transit industry. Indeed, she ran a transit district in Oregon until she ran it into the ground.

Thirteen indictments were filed against her for theft and official misconduct.

HB 2136 by Ryan Guillen (D- Rio Grande City) passed in 20\11 was supposed to require background checks for broker subcontractors. Perhaps the legislation should have been required for broker executives as well.

LogitiCare: Three Milwaukee Community Members Speak on It

On October 18, 2012, the Senate's Committee on Health, Revenue, Tax Fairness and Insurance held an information hearing on a massive privatization failure here and Wisconsin -- the

inability of Providence Service Corporation's LogistiCare to responsibly broker transportation for some of Wisconsin and America's most needy citizens.

As the citizens in this short video compilation demonstrate -- systematic failures go far beyond the ability of LogistiCare to handle the volume of service calls it receives and, even though a network of providers was available to handle all rides in the past, now claims that they can't find enough transportation providers.

Privatization schemes that reward companies with public moneys to withhold services that the public has paid-for upfront will always fail -- LogistiCare is acting as a gatekeeper, preventing qualified members from accessing important medical treatments and appointments and the only reason it appears to be doing so is to increase its profits.

LogistiCare Sticks it to Transporation Providers

When Milwaukee Journal Sentinel published a misleading report on a recent information hearing by the Wisconsin Senate's Committee on Health, Revenue, Tax Fairness and Insurance to hear test

imony on a massive privatization failure ind Wisconsin, they repeated the company's lies that non-emergency medical transportation was not being provided because of a lack of transit companies.

This is flat-out false and should have been dismissed out-of-hand. Under the previous system, there was no shortage of transportation providers and many more qualified people consistently go the rides they needed to covered health care appointments and services.

If you listen to the testimony here, you will clearly hear that LogistiCare and the media is misrepresenting the real problem, deflecting responsibility from where it belongs. LogistiCare is paid a flat-fee for each member that might need a ride to a covered medical service. If people don't need the rides, they keep the money.

And if the ride is a no show.... They keep the money. This privatization failure has little or nothing to do with the size of grossly inadequate phone service. This privatization failure has little or nothing to do with the availability of highly qualified transportation providers.

It appears this privatization failure is based on a contract that pays LogistiCare $38 million dollars and literally expects them to do nothing and forces all complaints back into the dysfunctional LogistiCare tele-communication centers where people are put on hold for up to an hour before being robo-transferred to the next indefinite hold.

LogistiCare FAIL

On October 18, 2012, the Wisconsin Senate's Committee on Health, Revenue, Tax Fairness and Insurance held an information hearing on a massive privatization failure here and Wisconsin -- the inability of Providence Service

Corporation's LogistiCare to responsibly broker transportation for some of Wisconsin and America's most needy citizens.
An AARP volunteer advocate explains how this privatization failure harms Wisconsin and America's most vulnerable citizens.

AARP Members want to remain in communities and homes as long as possible -- medical transportation is critical -- get people where they need to go. LogistiCare brokerage system is not working - those needing transportation for medical appointments and care are unable to make reservations and complaints.

Don't be mislead by the administration, LogistiCare, or media reports -- the problems are much deeper and more systematic than inadequate phone support. LogistiCare's failures are not do to a shortage of transit providers -- under the old system, there were plenty.

The problem is that LogistiCare is being paid at least $38 million -- a fee for each and every qualified member whether or not those members actually need transit services. LogistiCare's business model appears to be based on denying transportation -- even when those members need the ride to maintain their health and lives.

LogistiCare gets paid whether or not it provides any service and has anointed itself, in violation of state and federal laws, the only party which can receive complaints.

LogistiCare or LogistiSCARE: Milwaukee Hearing: Disability Rights Wisconsin Speaks

The record clearly shows that the implementation of a new privatization contract with Logisticare has resulted in LogistiCare's massive service failures which do not comply with terms and conditions of their state contract and appear to violate state and federal laws.

LogistiCare or LogistiSCARE?!?!?

The problem appears to be that LogistiCare is paid a flat fee for each and every member that might qualify for NEMT services if they had no other transportation to those appointments. Don't let the term no

n-emergency medical transportation fool you -- these are necessary rides to necessary doctor's appointments and other covered services. Covered health care needs are critical to maintain a reasonably healthy quality of life and, in some cases like dialysis or chemotherapy, they are life-or-death appointments. This privatization scheme, unbelievably to most who look at it, literally pays LogistiCare upfront whether or not services are actually provided. LogistiCare increases its profits by denying NEMT even when participants are fully-qualified and need this transportation service.

ALERT – ALERT — ALERT

The multi-year effort by TTA and your lobby team to protect TSAP/Medical Transportation Program services to local transit customers is again threatened.

Following a change in leadership within HHSC, the Full-Risk Broker proposal is back on the table and at the top of the agency’s list of proposals under consideration. Such a proposal would seriously and negatively impact revenue for most rural, and many small urban transit operations.

Hattiesburg resident Alex Bierre is seeking an investigation into the transportation service, LogistiCare

http://voicesnewspaper.blogspot.com/2012/09/audit-logisticare-this-privatization.html

How much is a life worth?  Does privatizing medical transportation services in Wisconsin for our neediest citizens actually save a dime if it undermines health care?  What if service failures may have contributed to a man's death because LogistiCare repeatedly left him without rides for weeks at a time despite the fact he needed regular dialysis?  How is it responsible to "privatize" a service that literally means life-or-death if those with exclusive government contracts maximize profits by denying necessary medical support services?

VOICES has been following and reporting on this massive privatization bamboozle which was initiated under Gov. Jim  Doyle's administration (please follow links at end of this article).  Last Week Milwaukee Journal Sentinel reported that despite assurances to the contrary, complaints continue to rise against LogistiCare transit service.

The MJS headline misleads by calling the increasing complaints a "spike", inappropriately implying that this is an anomaly -- in fact, this appears to be LogistiCare's business operating model and there is no reason to believe increases in missed rides is a "spike" instead of an ongoing trend.

While not the first time, VOICES published a letter demanding an audit in July, now 51 Wisconsin legislators, including republicans and democrats, are requesting that the state's Audit Bureau conduct a full audit of LogistiCare to resolve potentially life-threatening service failures.

It's. About. Time.

No one should want to see more tragic stories like the unfortunate 67-year-old Weyauwega man, Jim Barry, suffering liver failure, struggling with cancer, unable to drive, and absolutely depended on publicly-provided transportation for dialysis three times a week.  After 7 missed rides for dialysis that he absolutely needed to stay alive, Barry told the press shortly before he died: 

"I feel like they’re trying to kill me.  Yesterday, I made my funeral arrangements."

Rep. Penny Bernard Schaber (D-Appleton) initiated this new letter and issued the following statement:

"We're requesting a full program audit, which would require the nonpartisan Audit Bureau to look at the contract, financial things, pretty much everything,"

Bernard's letter points out that claims by LogistiCare that it is providing more responsive phone support are misleading -- their endless series of robo-voice-menues does not actually provide support, but LogistiCare misrepresents each call and transfer as being "customer services" -- blatantly false though some nooooze reports mislead this endless series of holds and transfers as being an "improvement."

Under LogistiCare's contract, they handle the complaint phone line and any reporting of complaints.  Under their services they claim that every call is answered within 3 minutes, however it counts the call as being answered if it transfers you to another robo-menu.

All summer, VOICES has been pointing out the dangers of systematic abuses when an organization like Logisticare is paid for services whether they are provided or not -- don't be mislead by the let the term "Non-Emergency Medical Transportation", rides to health care appointments certainly can and do have life-or-death consequences.

Because LogitiCare's business model and contract with the state is based on an assumptions of usage, LogitiCare has huge financial incentives to cheat the system by
denying rides -- they are actually paid whether the rides are delivered or not!

While Wisconsin Gov. Scott Walker's administration is not responsible for creating this nightmare, they are standing down while LogistiCare abuses their contract by failing to deliver rides despite the fact that they are being paid to provide their rides -- each "no show" for transportation allows LogistiCare to keep taxpayers money that was specifically provided to pay for that ride.

Disability groups have seen enough of LogistiCare and their massive service failure and are demanding the state to transfer quality control of LogistiCare to an independent company. Alan Freed, an attorney with Disability Rights Wisconsin, reports that since September 1st,  his agency is stunned to have received more than 100 complaints - well above the total it received in the two months after LogistiCare took over services for 600,000 Medicaid and BadgerCare recipients outside the greater Milwaukee area on July 1 last year.  LogistiCare's service failures are increasing despite promises to improve.

Freed states:

We're hoping to make them more aware of the extent of the problems that people have been representing to us," Freed said. "Being in Madison, I don't think they hear directly from riders. They're getting their information from LogistiCare.

We're hoping to give them some real anecdotal narratives from people who have suffered from bad results. We're hoping we can convince (the Department of Health Services) to exercise more oversight in the short run, at least to put pressure on LogistiCare to fix these start-up problems.

It's a question of the fox guarding the henhouse when LogistiCare is a clearinghouse of complaints.  And the state is only hearing about them after the fact through LogistiCare's logging of these complaint calls. Who's guarding the fox? What does DHS have in place to ensure that the information on complaints they're receiving from LogistiCare is actually reflective of the complaints people are making?

Wisconsin is not saving ny money -- funds designated to transport high-needs citizens to medical appointments are being siphoned off by a private company.  LogistiCare hides behind services failures that it has built into its system -- the huge numbers of missed rides and complaints is not by happenstance.

While Gov. Jim Dolye created this mess, it is time for Gov. Scott Walker's administration to clean it up, but they are shirking responsibility.  An audit has to be done and taxpayer monies should not go to companies that keep state funds by denying services they were contracted to provide.

LogistiCare FAIL: It's Not Just Wisconsin
LogistiCare FAIL: It's Not Just Wisconsin

On July 11, 2012, when we published a story about the failure of state transportation broker LogistiCare to provide rides which appears to have contributed to the death of a Waupaca Man in need of

regular dialysis, we knew from research that failure to provide services was not unique to Wisconsin.

Increasingly, it appears that the business model LogistiCare uses across the nation may be based on the premise that denying services to qualified people boosts its earnings -- even when failure to do so has life-or-death implications. Here's a report from Cheasapeake, VA:

[WVEC.com] Video | News | Weather | Sports

Mon Jul 23 10:01:04 PDT 2012
Medical transportation for Medicaid patients falls short

Chesapeake mom Rose Whybark is frustrated with the Logisticare medical transportation providers her son needs to make doctors’ appointments. view full article

In the Waupaca case, after missing at least 7 rides to dialysis appointments, 67 year-old Jim Barry told Waupaca County Post/Waupaca NOW:

"I feel like they’re trying to kill me. Yesterday, I made my funeral arrangements."

Mr. Barry, unfortunately, is no longer with us, indicating a massive failure on the part of LogistiCare -- problems that are being repeated across the nation. WVEC reports:

Rose Whybark of Chesapeake has had to find out the answer to that question more times than she wants. Her 17-year-old son, Gary, relies on Logisticare to get to and from his appointments. He has cerebral palsy and scoliosis that recently required back surgery. He has to be transported on a stretcher. Whybark says Gary often misses appointments because the transportation provider shows up late or not at all.

"His doctor appointments are important because we have to get weighed, plus blood work, because he has seizures. I have problems with everything with Logisticare at least six to eight times a year, and I feel that's a lot when your child goes to the doctor every three months," said Whybark.

Vicki Gilikin of Newport News has the same complaint. The Medicaid patient says her illnesses sometimes require as many as five doctors' appointments a week.

The report goes on to explain how repeated and consistent service failure results in this client having to seek medical attention at a hospital emergency. Perhaps this helps LogistiCare keep more of the more than 6 million dollars a month that the state of Virginia pays this private organization, but at what cost in terms of additional health care, human suffering, and even loss of life?

Milwaukee Journal Sentinel reported in August 2011, just 5 weeks into into LogistiCare's 3-year contract to provide Non Emergency Medical Transportation (NEMT) similar results in Wisconsin -- no-show rides, patients are arriving late to appointments, siblings aren't being permitted to ride together, and the company's mechanism for working with transportation providers is chaotic

Joe Sanfelippo, leasing manager for American United Taxi Cab of Milwaukee, states:

After nearly three weeks of trying to do business with LogistiCare, we gave up and refuse to accept rides from their company,". "They would email or fax a list of rides and, a couple of hours later, call and say not to do them. The next day at 9 or 10 in the morning, we'd get a list of rides for people with 8 a.m. appointments.

In Madison, Badger Cab. the only transportation company in Dane County to sign a contract with Logisticare, experienced even worse problems. After just one day of the bureacratic nightmare and endless customer service hold-times, this provider stopped accepting rides brokered by LogistiCare. Kurt Schneider, spokesman for Badger Cab explained:

[the company is] severing its relationship [with Logisticare because of ] numerous issues, including customer phone numbers and addresses provided by Logisticare that were riddled with errors and communications problems so serious that at one point on a chaotic Friday, according to accounts representative , four or five of his dispatchers could not take regular calls because they were trying to iron out problems with Logisticare customers.

Both Wisconsin newspapers identify a dysfunctional customer service system as a major part of the problem -- while LogistiCare claims that "99 percent" of the rides they broker are "complaint free", this proclaimation does not pass the smell test and appears to be the misleading results of a complaint process that prevents people from expressing concerns, much less provide resolution to transportation problems that, as Waupaca County learned, can literally kill.

WVEC 13 News Troubleshooters reports that in 2011 through March of 2012:

Logisticare transportation providers in the Hampton Roads region received 15,415 complaints for being tardy. 1,736 were for "no shows."

Logisticare's headquarters in Atlanta also gets an "F" rating from the Better Business Bureau; although, the Norfolk branch gets a "B."

LogistiCare reports that because they broker about 4 million rides per year in Virginia, so the problems being reported are statistically insignificant. Craig Marva of the Virginia Department of Medical Assistance Services, the agency that contracts with Logisticare states:

We do not know of any other state that requires a higher percentage of complaint-free trips. Although 99% of those trips are complaint-free, due to the overall volume and complexity of trips, there will still be errors and complaints and that is where both LogistiCare and the DMAS transportation staff focus our resources.

The last sentence above is curious, because in Dane and Milwaukee Counties, service providers can verify that LogistiCare's procedures and cumbersome requirements are responsible for service failures -- problems so sever that Badger Cab in Madison withdrew participation after 1 day and in Milwaukee, United Taxi Cab tried to work out problems with LogistiCare for nearly 3-weeks before giving up.

A County Transportation Director that has stepped forward to write reports for upcoming issues of VOICES Newspaper (starting in August), can document that typical hold-times when trying to contact LogistiCare are extremely long -- it is not unusual to spend an hour or more on hold!

The process that LogistiCare has implemented to document complaints/problems does not work and denies legally mandated fair hearings as required by law. When brought to LogistiCare's attention, they claimed that they would change procedures -- this transportation manager (who's identity we will protect until we publish his/her reports) has found that no real changes have taken place and continues to document outrageous hold times and endless run-arounds which some might even find comical if we weren't talking about life-or-death situations.

And even though LogistiCare itself has admitted that complaint procedures that were initially part of the contracted agreement with Wisconsin were inadequate, resulting in company announcements that they would change the process to be more responsive, in fact, LogistiCare has undermined any changes.

THIS announcement by ForwardHealth, (July 2012) announces the expansion of LogistiCare's operating territory to include HMO enrollees in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, and Racine Counties and identifies the same dysfunctional complaint process that LogistiCare announced it would change.

Is this a stealth attempt to undermine open, timely, and meaningful changes in the complaint process?

The Centers for Medicare & Medicaid Services outlines its expectations for complaints, appeals for denied services, and grievances.

The appeals and grievance process LogistiCare launched in Wisconsin and now appears to be reinstating by fiat with its latest service expansion appears to violate the letter and spirit of applicable federal mandates.

At-best, LogistiCare is demonstrating that they are incapable of monitoring themselves -- claims that they provide 99 percent of brokered rides without complaint are meaningless and even deceitful if they have structured their business model to prevent complaints.

A group of concerned Wisconsin professional, people with the greatest expertise and direct experience at the issues underlying these issues, have sent a letter (.pdf) to the Joint Legislative Audit Committee, Co-Chairs Sen. Cowles and Rep Kerkman, Senators Lazick, Darling, Vinehout, Lassa; Representatives Peterson, Vos, Jorgensen, and Richards. They are demanding a full program audit of LogistiCare.

The disturbing report from WVEC 13 News in Virginia confirms the need to:

Ensure Medicaid members have reasonable and timely access to transportation to Medicaid-covered services and document those that are denies seizes or have rides set up that are unreasonably late or don't show up at all.
Evaluate whether transportation services for Medicaid members use the most-economical mode of transportation available
Verify that fraud, waste, and abuse do not occur -- without a third-party monitoring this situation, it is not reasonable to expect potential problems in these areas to be fully-monitored
Reduce Medicaid expenditures while providing mandated services -- there is evidence to suggest that Medicaid and other state transportation aides are paying higher costs for individual rides than the exact same transportation services provided prior to contracting NEMT to private brokerage organization
More-fully compile and assess all data related to NEMT and related transportation services being provided so that every opportunity to seek reimbursements and other monies from available funding sources is explored and utilized.

At the heart of the problem appears to be a serious conflict of interest. Milwaukee Journal Sentinel reports that the 3-year contract with Wisconsin pays the company approximately $33 million per year while saving the state about $2.5 million, though there are reports that this figure is actually closer to $40 million.

The company gets its revenue from a flat rate applied to ALL people that may be qualified for brokered transportation services. If people do not use that service, for whatever reason (no need, no show, etc...) LogistiCare gets to pocket that money.

It is wrong to privatize health care services to Wisconsin's neediest citizens in a manner that allow out-of-state corporate conglomerates to increase their profits by flatly denying services for any reason and it is patently offensive (and perhaps criminal) if rides are routinely being denied because the appeal/grievance process is designed to discourage, prevent, and hide problems.

If there are misunderstandings in this process, LogistiCare is responsible for them. lease contact your state representatives and demand an operational audit of LogistiCare.

Failure to get people to health care appointments in a timely manner does not save anyone a dime and literally kills. Unfortunately, it appears denying these rides may increase profits for this state contractor.