Medicaid Transport Trims Drivers - Patients Say Service Has Become Unreliable

Medicaid Transport Firm Trims Drivers
Patients Say Service Has Become Unreliable

By Sindya N. Bhanoo
Washington Post Staff Writer
Saturday, August 16, 2008; B01

The company that oversees the transport of more than 50,000 Medicaid patients in the District has downsized its pool of contract drivers, leaving some clients to complain that the service is too unreliable to get them to important health-care appointments.

The Missouri-based Medical Transportation Management, which struggled with similar complaints after taking over in October, severed ties with several dozen drivers in July to save money and reconfigure its service strategy, said Sandra Whittaker, an MTM spokeswoman. The Washington Post calculates that the number of drivers dismissed is about 60. MTM would only confirm that it has contracts with 21 drivers and previously had as many as 87.

"All of a sudden. I was called and told I had new transportation," said Betty Turner, a kidney dialysis patient who takes a van to treatment three times a week. Last week, when Turner was still weak after dialysis, she waited an hour for her new driver. Fed up, she then rolled 1 1/2 miles home in her electric wheelchair.

"I tell you, my family wasn't happy about that," Turner, 60, said. "It took an hour to get home, and something could have happened."

Whittaker said the company is addressing such disruptions and is in the process of redirecting more patients to rail and bus services. The company coordinates government-provided rail, bus, MetroAccess and van transportation. It does not own any vehicles, employs drivers with vans as subcontractors and now has 21 van drivers, she said.

Currently, MTM coordinates about 4,000 trips a month using public transportation and 48,000 with van services, according to company reports submitted to the District's Health Department.

"Very frankly, MTM was losing money before," said Rob Maruca, senior deputy director of the Medical Assistance Administration for the District. "They are going to have to move people to Metrobus and Metrorail just to break even."

Some drivers who lost contracts, however, said that MTM owes them thousands of dollars and that the downsizing is MTM's effort to avoid that debt.

MTM said it is operating in good faith.

Meanwhile, some clients say they're stuck in the middle.

Elaine Pope, the daughter of a dialysis patient whose new driver did not show up for several days, has run out of patience. "Don't they know she can die if she misses her appointment?" Pope said of her 82-year-old mother, Mavis Cheek.

Cheek waited more than an hour for a driver to arrive last week. Finally, Cheek called her son-in-law to pick her up. After four days of calling MTM, Pope was able to arrange a driver for her mother.

MTM was awarded a five-year, $55 million contract with the District last summer after an audit by the Inspector General's Office determined that the Health Department could not provide documentation on millions of dollars spent on Medicaid patient transportation.

When MTM took over, clients and social workers complained of missed appointments and stranded patients. MTM admitted to having trouble and pledged to sort out the issues.

The Health Department has monitored MTM's performance since, Maruca said, reviewing monthly reports on trips MTM coordinates.

"The experience has been very good," Maruca said. "We had a couple problems early on with patients getting picked up and again a few now, but we've sorted it out."

MTM requires medical providers to fill out forms for Medicaid patients, rating their physical and mental abilities. It uses the information to determine transportation needs, but it declined to explain details of how decisions are made.

"It is their form," Maruca said. "I don't know what they use to make the determination."

MTM sent contract driver Laura Robinson a termination notice a month in advance, as her contract specifies, they also canceled her patients for the upcoming month, Robinson said. "It's the same as terminating our services without notice," she said.

Whittaker said, however, "All actions taken to reduce the number of transportation providers in the network were done in accordance with the contractual agreement between the providers and MTM."

Another driver, who did not want his name used because the dispute is unsettled, said MTM also gave him a month's notice and canceled all but one of his patients.

"I can't afford to transport one patient," he said. He said that MTM owes him payments from as far back as February but that company alleges that he owes it more than $78,000.

Robinson said her termination letter also said she owed MTM more than $100,000. The letter offers to cancel out that amount in exchange for settling debts MTM owes to Robinson, she said.

"It's a threat tactic," Robinson said. "They owe us money, but they are trying to scare us into settling. We won't do it."

MTM has a spotty contractual history. In 2005, Missouri's state attorney general accused it of fraud and violation of contracts. MTM settled out of court and paid the state $2.4 million. Although the city was aware of MTM's settlement in Missouri when the pact was awarded, there was nothing that precluded the company from entering the bidding process, said Briant Coleman, spokesman for the District's Office of Contracts and Procurements.

"MTM had a satisfactory performance record as well as letters of reference," he said.

Most legal issues remain between MTM and the drivers, but the city will get involved if drivers have not been paid, Coleman said.

According to the contracting office, only one driver has called this week to complain about payment.

Council member David A. Catania (I-At Large), who lobbied for the city to hire a single medical transportation provider, said the problems are growing pains.

"In less than a year, we have been trying to correct what was a joke of a system, and obviously there have been transition issues," he said.

Patients like Cheek and Turner are just waiting for a solution -- and a dependable ride.

"All this changing up of drivers is too much," Cheek said. "I just need someone regular."

"I got a call from my driver, and he apologized," Turner said. "But this week will tell the tale of whether they are capable."

http://www.washingtonpost.com/wp-dyn/content/article/2008/08/15/AR2008081503301.html