MART: The Broker’s Duty to Verify the Ride

In the MART Medicaid transportation settlement, Montachusett Regional Transportation Authority agreed to pay $300,000 to resolve allegations that it billed MassHealth for rides its contracted transportation companies never provided. The public broker had a contractual duty to verify those rides. If you review vendor invoices, manage transportation contracts or approve reimbursement claims, this case concerns the work between a company saying it drove a patient and Medicaid paying for the trip.

What MART Was Paid to Do

MART arranged rides for MassHealth members, paid the transportation companies and sought reimbursement from MassHealth. The state’s Executive Office of Health and Human Services also paid MART a management fee for its brokerage services. The government was paying for someone to manage the transportation as well as for the rides themselves.

MassHealth is Massachusetts’ Medicaid program, jointly financed by the federal government. As the Justice Department’s account of the arrangement explains, MassHealth had to provide members with non-emergency transportation to and from covered medical appointments. It used brokers, including MART, to help members find those rides. MART then contracted with third-party transportation companies to carry them out.

That payment path puts a broker in a consequential position in Medicaid transportation fraud. The vendor gives its account of the ride to the broker. The broker pays the vendor and makes its own reimbursement claim to the state. In MART’s arrangement, the verification obligation sat inside that chain, alongside the authority’s role as the party asking MassHealth for money.

The Contract Required a Check on the Ride

MART’s contract made checking the performed trip part of its brokerage work. The Justice Department reproduced the contractual language describing what MART had to have:

The contract called for a check connecting scheduled and billed trips to the service actually delivered. It reached the quality and timing of the trip, too.

The Allegations Covered Thousands of Unprovided Rides

The government alleged that MART submitted claims for thousands of rides its contracted transportation companies did not provide, from January 1, 2011 through December 31, 2015. Its account tied those claims to verification procedures that allegedly failed to prevent false vendor invoices from becoming MassHealth bills.

The sequence matters. According to the allegations described in the announcement, transportation companies sent false invoices to MART. MART then billed the invoiced amounts to MassHealth.

A provider-side case shows the distinction. In its 2017 settlement announcement concerning Employment & Assessment Solutions, the Justice Department described allegations that the transportation company and its principal billed TennCare for services never provided, including purported rides for people who were hospitalized or incarcerated. There, the allegation concerned the transportation provider’s own claims about its services. In MART’s case, the government pursued the public broker over claims arising from its handling of contracted vendors’ invoices. The same missing ride can raise questions at different places in the payment chain.

Why the Broker’s Contract Matters Beyond Massachusetts

The oversight problem survives changes in how transportation is paid for. The 1999 report Controlling Fraud and Abuse in Medicaid: Innovations and Obstacles, from seminars sponsored by the Health Care Financing Administration, described Arkansas responding to extensive improper transportation billing with regional contracts. Contractors received a monthly fee, replacing individual fee-for-service claims from multiple providers. State officials then reported a need for enough capacity to oversee the new contracts effectively.

The lesson for a broker case is practical: a different payment arrangement still leaves someone responsible for checking the service.

Are There Any Checks on Medicaid Fraud?

Yes. Transportation brokers can compare where a vehicle was, when a trip happened and who signed off on it with the service being billed. The Centers for Medicare & Medicaid Services’ Georgia Comprehensive Program Integrity Review, published in December 2014, described a broker using driver tablets to make those comparisons possible.

The tablets recorded location and time-stamped trips. The broker could compare a vehicle’s location with the designated pickup point, examine drop-off information and detect a provider claiming to be in two places at once. The software could also compare the electronic signatures of drivers signing off after trips. Those are concrete tests of a billed journey, reaching beyond the amount on an invoice.

The same review showed how much depended on the organization doing the checking. One Georgia broker performed no proactive analysis for unusual billing patterns and had no special investigations unit. Neither its state contract nor its internal policies required it to verify receipt of Medicaid services with beneficiaries.

For someone inside a transportation broker, that is a recognizable difference: possessing trip information and running a process that acts on it are separate pieces of work.

The Civil Settlement Reached the Public Broker

The Justice Department and the Massachusetts Attorney General announced MART’s agreement on July 21, 2020. It resolved allegations under the False Claims Act.

What Evidence Is Needed to Prove Fraud?

Your knowledge of how rides were approved and billed can give meaning to records such as vendor invoices and trip logs. We help insiders turn those records and what they know into their strongest whistleblower case.

A vendor manager may know how performance was reviewed. A billing or compliance employee may understand which checks happened before a reimbursement claim went out. Their knowledge can explain how an apparently routine bill passed through a process that was supposed to verify it.

A whistleblower case under the False Claims Act can pay a reward of 15% to 30% of what the government recovers.

When the Invoice Outran the Verification

If you know how unverified vendor bills became Medicaid claims, speak to one of our whistleblower experts about how those rides got billed. We build your strongest Medicaid transportation whistleblower case with you around the broker’s promises, the rides and the billing decisions, and bring in Medicaid transportation whistleblower lawyers who understand those connections. We remain your partners from the first conversation through the pursuit of a recovery.