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HCPF seeks $2.25M to continue non‑emergency medical transport fraud reviews and to move to a statewide broker
Summary
The Health Care Policy and Financing department told the Joint Budget Committee its prepayment reviews identified more than $14.4M in inappropriate NEMT payments; HCPF requested funding to continue clearing questionable claims and to implement a statewide broker model intended to reduce fraud and improve payment accuracy.
Health Care Policy and Financing (HCPF) told the Joint Budget Committee the department has reviewed over 30,000 non‑emergency medical transportation (NEMT) claims and estimated it prevented about $14.4 million in inappropriate payments. The department requested roughly $2.25 million to continue prepayment reviews and to develop a centralized statewide broker to reduce fraud and improve administration of NEMT services.
HCPF Budget Director Erin Gates told the committee that the department does not believe there is a large volume of unpaid legitimate providers — though members reported hearing anecdotes of providers who claim they are owed large sums. Gates said the funds requested would help the department clear claims that remain in prepayment review and transition to a statewide broker model that the department and stakeholders have been working on since fiscal 2019.
Why it matters: Committee members expressed concern about legitimate providers who say they have not been paid; the department acknowledged prepayment reviews can create payment delays for valid claims and said the requested funding will help address the backlog while improving fraud detection with data analytics.
Program design and stakeholder engagement: HCPF said it ran a request for information (RFI) and received positive feedback from potential vendors for a statewide broker approach; differences between a 9‑county broker model and a statewide broker, as well as earlier operational challenges, informed the department’s plan to refine procurement and stakeholder engagement before full implementation.
Next steps: The committee did not take a stand‑alone recorded vote on the request but staff recommended including the funding in the supplemental package so HCPF can continue claim reviews, transition to a statewide broker and minimize payment disruption for valid providers.
