Colorado's Medicaid program suspended its contract with one of the state's largest non-emergency medical transport companies on Friday.
MedRide provides Non-Emergent Medical Transportation (NEMT) for Medicaid users who have no alternate form of transportation to medical appointments covered by Medicaid. The company runs more than 375,000 rides a year across the state and is headquartered in Colorado Springs.
The Department of Health Care Policy and Financing, which oversees Health First Colorado, the state's Medicaid program, announced the suspension citing issues with the claims submitted from MedRide to the state.
"HCPF previously provided MedRide with opportunities and extensions to come into compliance and to address identified concerns, and they have not done so," a statement from the department read.
MedRide was ordered to notify clients with scheduled rides on or after Friday to find an alternate provider or reach out to Medicaid member assistance before the suspension. MedRide spokesperson Andy Boian said the company filed a temporary restraining order challenging the suspension Thursday evening, but Friday rides were canceled.
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According to documents released by the state, the suspension of MedRide as a Medicaid provider was prompted by concerns about claims submitted with deficiencies like missing member signatures, dates, times and other necessary documentation on "nearly every" ride claim reviewed of more than 52 miles.
MedRide is not the first NEMT provider to face scrutiny and a suspension from its contract with Health First Colorado after the Department of Health Care Policy and Financing discovered an alleged major fraud scheme within the NEMT network in 2023. The alleged scheme involved a handful of providers intentionally transporting patients long distances for services to drive up Medicaid reimbursements. The agency has since put strong emphasis on audits of NEMT provider trips, particularly those over 52 miles round trip.
In response to finding fraudulent billing for rides, the state agency suspended some providers' contracts and put a moratorium on all new NEMT applications. The six-month enrollment freeze has been extended twice, now until at least April.
In a statement, the department said that the suspension was in line with the agency's efforts to root out fraud and ensure the safety of Medicaid recipients.
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"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. Being sound stewards of taxpayer dollars is also a top priority for HCPF in administering Colorado's Medicaid program."
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Boian said MedRide was pushing back against allegations that the company failed to comply with state regulations, accusing the state agency of frequently "moving the goalposts" on required ride documentation.
"We met each one of those objectives that they say that we haven't," he said.
Other providers said they are concerned about picking up the slack during the suspension, especially in rural areas where MedRide was a more dominant provider. According to court filings submitted by MedRide, the company provided about 69.5% of rural Colorado NEMT trips in the first half of 2024.
Barb Sandoval, a NEMT provider out of Crowley County east of Pueblo, said she was receiving multiple calls a day since the announcement of the suspension inquiring about alternate transportation.
"Whatever is happening, it's causing a lot of Medicaid recipients to not have transportation," she said.
As an NEMT provider with one vehicle, Sandoval cannot increase her capacity for clients. She said that rural NEMT drivers like her must often make trips longer than 52 miles because Medicaid clients often live far away from specialized care. As such, she was also subject to increased scrutiny from the Department of Health Care Policy and Financing, resulting in a 14-month suspension on payment last year while the state audited her claims.
She said that MedRide had a good reputation in her area.
"They have some of the (most) courteous, kindest, respectful drivers to clients," she said.
Kelly Duncan, a receptionist at Cañon City Golden Age Council, which houses NEMT transit for Fremont County, said that the organization was getting "quite a few" inquiries for rides Thursday, a day before the suspension. Duncan said she typically tries to schedule rides for medical appointments to Pueblo and Colorado Springs at least two weeks out, but that the organization was attempting to find drivers for trips within 48 hours.
"I don't think we'll be able to catch everybody, but we'll do what we can," she said.
Medicaid members requiring rescheduled rides can access a list of providers on the HCPF website.