Syracuse company stung by Medicaid probe
Fri, 22 Jan 2010 21:38:21 GMT —
The state has ordered a Syracuse-based company to change the way it does business and return $80,000 in questionable medicaid reimbursements.
The New York State Office of Medicaid Inspector General recently concluded a months-long investigation into Medical Answering Services which pre-authorizes and dispatches transportation for medicaid recipients. MAS deals with numerous taxi, ambulance, and bus companies in a 9 county area. Company officials say it handles approximately 2,000 calls a day.
The Inspector General found the company was not properly authorized to bill medicaid on behalf of transportation companies. As part of a settlement, Medical Answering Services agreed to pay back $80,000 as well as sign a "Corporate Integrity Agreement." According to Deputy Inspector General Robert Hussar, the agreement requires MAS to hire an in-house compliance officer, adopt a code of conduct, undertake internal audits and improve training. Hussar told CNYcentral he "wouldn't classify (the activities) as fraudulent, but certainly an abusive violation of rules."
Russell Maxwell of Medical Answering Services said, " We look forward to meeting all the obligations under the program." Maxwell calls the $80,000 payback, "a settlement agreement." When asked if he was denying wrongdoing, Maxwell replied, "There's a difference of agreement as to what happened and how it happened." Maxwell points out the billing arrangement was approved by the Onondaga County Board of Ethics.
Onondaga County Social Services Commissioner David Sutkowy calls the problems uncovered by the Medicaid Inspector General, "technical violations." Sutkowy added, "neither the taxpayers, the public or providers suffered in any way."
One person who adamantly disagrees is Anne Woodlen, a medicaid recipient who has complained about "poor service" from Medical Answering Services for years. Her complaints to the State Health Department helped spark the Inspector General's probe. "I think it's fantastic." Woodlen said of the Corporate Integrity Agreement, "It's a total slam. People in the industry are reading it and being awed."
Woodlen says she was subjected to "non-stop retaliation and retribution" after she began lodging complaints against Medical Answering Service." Woodlen claims Onondaga County officials blocked her from receiving medicaid transportation services on two occasions. When asked if she felt vindicated by the Medicaid Inspector General, Woodlen said, "I have always known I was right about this."
Both Maxwell and Sutkowy say they can not respond to Woodlen's claims citing patient confidentiality laws.
Woodlen has written a synopsis of her dealings with MAS and Onondaga County. You can read it below.
In this county, more than 20,000 poor, sick people use Medicaid transportation. Vendors bill the state about $8 million a year. It is big business.
Around 2002, the County Dept. of Social Services issued an RFP for the dispatch contract worth about $250,000. There were half a dozen bidders and the contract was awarded to Rural Metro. Five months into the contract, Rural Metro told the county they didn TMt want it and were assigning it to Medical Answering Services, which consisted of two of their ambulance drivers, Russell Maxwell and Wayne Freeman.
Why would a company bid a three-year contract and then resign from it after five months? Who benefited? Did Rural Metro have any intention of serving the contract or were they just a pass-through so Freeman and Maxwell could get it?
At the time, Maxwell and Freeman, doing business as Medical Answering Services, only had a post office box. They did not have a place of business, relevant corporate experience, or a supportive corporate structure. Social Services gave them the contract without checking to see if they could service it. The contract did not go through the Division of Purchasing. In fact, the county gave MAS the contract before they were they legally incorporated.
From the get-go, MAS practices were incompetent and apparently corrupt. They sent vendors to the wrong addresses on the wrong days at the wrong times. The vendors paid the bill; you can TMt bill the state for a mistake. Clearly, certain vendors were being given preference over others in defiance of Fair Trade regulations.
Shortly after MAS opened its own office, they had to partially shut down to install new telephone trunk lines. They lacked minimal preparedness to do business. Waits on telephone hold before MAS would answer a patient TMs call continued to be as long as forty minutes. Currently, if you haven TMt been on hold for at least ten minutes, then MAS doesn TMt see a problem.
Kathy Hart, then-DSS assistant commissioner for Medicaid, was running the show. She was on the phone or computer with operating manager Wayne Freeman every few hours. He didn TMt know what he was doing; she was teaching him.
Freeman carried the title of Director of the Onondaga County Medicaid Dispatch Center. In fact, he is a private businessman and had no business using the title. Apparently it was authorized by Hart.
My personal experience was that I couldn TMt get to my doctors TM appointments. MAS got so much wrong so often that my rides didn TMt show up. I repeatedly missed essential doctors TM appointments. The situation was so bad that two of my doctor TMs used to send their secretaries to bring me in.
I began to file complaints, first with the general manager of Rural Metro, then Wayne Freeman, Kathy Hart, DSS Commissioner David Sutkowy, and Legislator Kathy Rapp.
Unbeknownst to me, Wayne Freeman was taping my phone calls. DSS had me followed.
I filed a complaint with the NYS Dept. of Health. When the county DSS found out, Chief Welfare Attorney Zachery Karmen, claiming to be following Sutkowy TMs direction, denied me Medicaid transportation. That is a violation of regulations.
Before a Medicaid patient TMs services can be changed, the patient must receive thirty days written notice, with notification of the right to a fair hearing. I got no such notification from Karmen, et al.
When I filed for a fair hearing, I could not get legal representation. Zachery Karmen"who almost always leaves fair hearings to his staff"faced me himself. Not surprisingly, I lost and thereafter had to take Call-a-Bus.
I filed a complaint with the NYS Office of the Welfare Inspector General. Shortly thereafter I had access to an email I wasn TMt supposed to see. In it, Karmen identified himself as my enemy, and indicated that he was going to call the Inspector General.
Previously, a television reporter had expressed interest in the story but dropped it after Karmen led him to believe that I was going to be charged with Medicaid fraud. Consequent to Karmen TMs email, the Inspector General did not investigate.
Working through Senator David Valesky TMs office, I filed a complaint with the newly created NYS Office of the Medicaid Inspector General (OMIG). Then I became so sick that I could no longer take the bus. My doctor ordered, and I received, Medicaid transportation (I travel by wheelchair) for two weeks"then Freeman again canceled it without warning or written notice.
OMIG began to investigate Medical Answering Services and I laid home in bed. Denied access to medical treatment, I became so sick that I lost my part-time job (it was the first time I TMd worked in over a decade). I also became so sick that when I did get back to the doctor, I needed to be hospitalized.
Instead of providing medical care so I could return to work and become a taxpayer, the county made me sicker and forced the taxpayers to pay for increased care. Is that what the government is supposed to be doing?
Months later, in a second fair hearing, I again went one-on-one with Zach Karmen. I won"not because I was a trained lawyer, but because I was right.
In that hearing, Freeman testified that he had canceled my rides on orders from Karmen. My doctor ordered transportation, and a lawyer and a businessman, working for the county, denied it. Freeman testified that he had also discussed my situation with Sutkowy. This was not solely about Medical Answering Services"this was about the Onondaga County Dept. of Social Services engaging in aggressive retaliation against me for reporting wrongdoing in Medicaid.
The Inspector General TMs investigation revealed that Medical Answering Services is currently doing business in nine counties. OMIG TMs investigation does not reveal significant misconduct in any county except Onondaga. It is not just about MAS"it is about the Onondaga County government. Between MAS and Onondaga County there has been"and continues to be"a very wrong relationship.
In addition to paying back $80,000 in wrongfully gathered money, MAS had to sign a 30-page Corporate Integrity Agreement, which locks them in a vise so tight that even the county can TMt get them out of it. MAS has to hire an impartial Independent Review Organization. They have to develop a code of ethics, check their employees for criminal records, substantially improve their training methods, and report all co-owners, investments and other alliances. OMIG has such tight reporting on MAS that if they take a crap, they have to report how many pieces of toilet paper they use.
The penalty for violating the Corporate Integrity Agreement is $1000/day for any of several violations"which can run concurrently"and $10,000 for lying on any certificate. OMIG reserves the right to exclude Medical Answering Services from receiving any Medicaid payments. Such exclusion pretty well puts a company out of business.
MAS TM contract with Onondaga County expired in December 2008. According to the information I was given, the county extended MAS TM contract because it was being investigated!
Last year, I spoke to the Onondaga County Legislature several times, as well as the Legislature TMs Social Services Committee. The County Attorney TMs Office tried to stop me from speaking by using intimidation, and telling lies about the Inspector General TMs Office.
I variously bullied, berated and beguiled DSS"David Sutkowy"into finally issuing an RFP for a new contract. Again, the contract was not being run through the Div. of Purchasing. Zachery Karmen"a Welfare attorney"was serving as counsel on a purchasing contract.
Recently I learned that DSS has pulled the RFP, no reason given. The Onondaga County Dept. of Social Services under Commissioner David Sutkowy is extending the no-bid contract, now worth about $300,000, to Wayne Freeman and Russell Maxwell, who have done so many bad things that the Inspector General has locked them into a Corporate Integrity Agreement (CIA) for three years and required them to pay back $80,000.
The CIA also prohibits MAS from engaging in retaliation and retribution. The Inspector General TMs got my back, and the county damn well has to leave me alone now. Medicaid money was not being spent to give the taxpayers what they were paying for. I did something about it.
Now, here TMs my question: who TMs going to do something about the corruption in county government?Sincerely,Anne C. Woodlen