Colorado Springs resident Jonathan Jones had a colonoscopy lined up for Friday, but he got an unpleasant surprise the day before — he received a call telling him his ride from a free transportation service for Medicaid patients was canceled. He was told the state’s Medicaid agency was withholding funding for the company, called MedRide.
Like a Super Bowl quarterback, Jones had to scramble.
“I managed to borrow money from a relative to take an Uber to my appointments (Friday),” he said. “That will cost about $70 round trip, which is not something I can continue to afford.”
He said he has gastrointestinal problems and uses the service regularly. “I have ongoing medical issues that I have to get to, not only doctors here in Colorado Springs, but I often have to go up to Denver for treatment,” he said.
He’s not alone in feeling the pinch.
MedRide runs more than 300 cars for the service and gives more than 420,000 rides a year, many across rural Colorado. A spokesman said it’s the state’s largest provider of this service, officially called non-emergent medical transportation, which provides rides to and from medically necessary services covered by Health First Colorado — Colorado’s Medicaid program — for its members who have no other way to get to those appointments.
The situation came to a head following a dispute over documentation for reimbursement payments between MedRide and the agency, the Colorado Department of Health Care Policy and Financing (HCPF), which administers the Medicaid program.
In November, agency staff met with company’s president and owner, Gregory Harriman, and followed up with a letter. The department said it had pulled MedRide claims for reimbursement to the agency for longer trips, those of more than 52 miles. Initial reviews found what it called “significant deficiencies.” Those included missing signatures from Medicaid members requesting rides, missing dates and times, claims forms missing up to three columns due to poor scanning “in nearly every claim,” according to the letter from Medicaid director Adela Flores-Brennan, which HCPF provided to CPR.
MedRide said the agency is holding back “several million in claims,” which was presenting a financial hardship for the company.
The agency said MedRide would need to “submit clean claims,” with the supporting documentation, and confirm “driver background checks and vehicle inspections,” by the start of February, or risk suspension and repayment of “identified improper payments.”
By February, the situation had not been resolved, so the agency sent another letter saying HCPF had identified that MedRide as being involved in “an alleged and ongoing organized fraud scheme,” totaling more than $1 million, and suspending the company.
“Our members’ safety is of paramount importance to HCPF. We must ensure that our members have the assistance they need to get to their appointments, and we must ensure they are transported safely with reliable drivers and safe vehicles,” said HCPF spokesman Marc Williams in a statement. “Being sound stewards of taxpayer dollars is also a top priority for HCPF in administering Colorado’s Medicaid program. With that in mind, HCPF has implemented credentialing requirements for (non-emergent medical transportation) providers and their vehicles, as well as measures to improve integrity and accountability in the program overall, especially given the organized fraud identified within the NEMT industry here in Colorado, Arizona, New York and in other states across the nation.”
He said both the agency and MedRide contacted Health First Colorado members in the MedRide service areas to advise them of the suspension, directing them to the state’s NEMT Provider Directory and a phone number (800-221-3943) to find a different ride.
A spokesman for MedRide, Andy Boian, said it was working with the state to resolve the situation. “We are working as hard as we can to try to figure out what the state needs to revalidate us,” he said.
He said the state had launched a fraud investigation regarding rides for Medicaid patients in the fall of 2023, that involved smaller companies.
“But the investigations continued and they have originally accused us of fraud and now debunked that,” he said. “So we are not under investigation for fraud, but what has transpired is that the state, and particularly HCPF, happens to continually move the goalpost on requirements for being validated to transport Medicaid patients in Colorado.”
“We’ve complied with all requirements from the state of Colorado, and they call back with more. We comply with more,” he said.
He said the agency had changed requirements for signatures on trips both to and from a destination, plus two documents that were unsigned by the patient on the return trip.
“So they now have basically refused to revalidate our program and our offering. And it’s a little bit perplexing to us, but we’re doing our best to get back online and get revalidated as soon as possible,” Boian said.
For his part, Jones, the Medicaid patient in Colorado Springs, said he hoped the MedRide standoff would be resolved soon.
“Since they bill Medicaid directly, I don’t really have to do any paperwork or anything. It’s been as smooth as possible.”
