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West Virginia Income Maintenance Manual Chapter 27

West Virginia Income Maintenance Manual Page 12 Chapter 27 Non-Emergency Medical Transportation (NEMT)

27.6 BENEFIT REPAYMENT Members must be informed that fraudulent claims will result in denial of subsequent requests up to the amount of the claim, and could result in permanent ineligibility for non-emergency medical transportation (NEMT). When the broker is aware that a client may be obtaining NEMT reimbursements to which he is not entitled, the broker must monitor all requests from the client to determine if misuse or abuse of the program is actually taking place. Any information deemed questionable must be verified, even if not routinely required. If the broker has reason to suspect that reimbursement is being requested for trips that were not taken, he must contact the medical provider(s) listed and verify appointment dates and whether or not the appointments were kept. A referral must be made to Bureau for Medical Services (BMS) and Office of the Inspector General (OIG) to notify the agencies of potential fraud, waste, and abuse.

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Page 2173

Official source

West Virginia Income Maintenance Manual Chapter 27

West Virginia Income Maintenance Manual Page 12 Chapter 27 Non-Emergency Medical Transportation (NEMT)

27.6 BENEFIT REPAYMENT Members must be informed that fraudulent claims will result in denial of subsequent requests up to the amount of the claim, and could result in permanent ineligibility for non-emergency medical transportation (NEMT). When the broker is aware that a client may be obtaining NEMT reimbursements to which he is not entitled, the broker must monitor all requests from the client to determine if misuse or abuse of the program is actually taking place. Any information deemed questionable must be verified, even if not routinely required. If the broker has reason to suspect that reimbursement is being requested for trips that were not taken, he must contact the medical provider(s) listed and verify appointment dates and whether or not the appointments were kept. A referral must be made to Bureau for Medical Services (BMS) and Office of the Inspector General (OIG) to notify the agencies of potential fraud, waste, and abuse.