Employment & Assessment Solutions: False Medicaid Trips and a Nine-Year Exclusion

In the Employment Assessment Solutions Medicaid fraud settlement, the company and its principal agreed to pay $550,000 to resolve allegations of billing TennCare for transportation services never provided. A federal investigator called the alleged rides ghost transports: the passengers included people who were hospitalized or incarcerated at the time of the supposed ride. For someone working in dispatch or billing, that is a concrete question: where was the passenger when the claim said the trip happened?

Employment & Assessment Solutions, Inc. was a Nashville transportation provider serving beneficiaries of TennCare, Tennessee’s Medicaid program. The United States and Tennessee alleged that the company and its principal caused false transportation claims to be submitted between January 2, 2010, and April 30, 2014.

The U.S. Attorney’s Office for the Middle District of Tennessee announced the settlement on August 24, 2017. The case puts a particular form of Medicaid transportation fraud in focus: a claim for carrying a person who allegedly never took the ride.

Hospital and Custody Dates Behind the Allegations

The government’s allegation was that transportation never occurred, including purported trips for people who were in a hospital or incarcerated at the time. That puts the passenger’s whereabouts at the center of the claim. A bill says the company transported someone. The person’s history can tell a different story.

We see the absurdity in what TennCare allegedly bought: an empty seat billed as though it held a patient. The program and the people who depend on it were supposed to get a ride for that money.

The useful comparison is specific to the claimed journey. We want to understand the passenger, the date, the pickup and destination, and what the hospital or custody record says about that time. The question is whether that particular ride occurred, with that passenger, as the claim represented it.

What Evidence Is Needed to Prove Fraud?

For an alleged false trip, the useful evidence connects the transportation claim to the passenger’s actual movements and to the people who created or approved the billing. Dispatch records, trip logs and claims describe the provider’s account. Hospital or incarceration dates provide a separate account against which to test it.

The Harvard University report Controlling Fraud and Abuse in Medicaid: Innovations and Obstacles, published in 1999, described an Illinois review that combined medical records, patient interviews and patient histories from seven days before and after a claimed service.

The same report described a Texas method that brought together claims for the same patient on the same day. That allowed reviewers to identify duplicate submissions from different providers and apparently incompatible services. Each bill could look ordinary by itself. The conflict appeared when the bills were read together.

A dispatch log and a passenger’s whereabouts can tell different stories. We put them side by side with you, drawing on your knowledge of the drivers, vehicles and entries to understand the claimed ride.

The other part is what the business knew when it sought payment. An instruction to bill, an approval or a response to a disputed trip can connect the discrepancy to a decision inside the company. Those are the connections we examine in a prospective case, alongside the claim and the underlying service records.

The Vendor Bills for the Ride, the Broker Checks It

Transportation companies and transportation brokers occupy different places in the payment chain. A vendor supplies the ride. A broker arranges transportation and may pay the vendor, with verification responsibilities defined by its contract. That distinction matters when following a false invoice into a Medicaid claim.

The broker’s verification duty was the issue in a separate Massachusetts settlement. Montachusett Regional Transportation Authority, acting as MassHealth’s broker, agreed to pay $300,000 in a settlement announced on July 21, 2020. The government alleged that the authority submitted reimbursement claims for thousands of rides its contracted transportation companies never provided.

According to that announcement, the broker’s contract required procedures to verify that scheduled trips were performed as authorized and billed. The government alleged that insufficient verification allowed vendors to submit false invoices, which the broker then billed to MassHealth.

The Tennessee settlement concerned the transportation provider and its principal. The Massachusetts settlement concerned the broker’s handling of contracted providers’ invoices. We follow both the service records and the billing chain to understand who supplied the ride and who sought payment for it.

The Company and Its Principal Each Accepted an Exclusion

The company and its principal each agreed to a nine-year exclusion from Medicaid, Medicare and all federal healthcare programs as part of the civil settlement.

The Tennessee Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, the Tennessee Attorney General’s Office and the U.S. Attorney’s Office for the Middle District of Tennessee investigated the case.

A Different Payment Model Still Needs Someone to Check the Rides

The Harvard report described Arkansas replacing individual transportation claims with regional contracts that paid contractors by the month, in response to extensive improper billing.

The report then identified the problem that remained:

The bill changed. The need to check the service remained.

The alleged hospital and incarceration conflicts in the Tennessee case bring that oversight question back to a person and a date: who checked whether the passenger took the ride?

What a Transportation Insider Can Add

A dispatcher, biller or manager may understand a trip entry in ways the claim alone cannot explain. If you know who was assigned to drive, why a journey was canceled or who approved billing after a dispute, that account gives us a way to connect the paperwork to the decisions behind it.

We examine those details with you against the claims, service records and payment arrangement. The Tennessee allegations show the value of looking outside the transportation company’s own billing description. The broker case shows why the next business in the chain also matters. Your knowledge connects those parts of the story.

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

You Know the Trips Behind the Billing

If the rides you dispatched or billed do not match the passenger records, speak with our whistleblower experts about what happened. We build your strongest Medicaid transportation whistleblower case with you. We bring in Medicaid transportation fraud whistleblower lawyers who understand provider billing and broker contracts, and stay beside you through the pursuit of a recovery.