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Audit finds poor performance by state’s Medicaid transportation broker, including cancer patient who waited 5 hours for pickup

Hartford Courant - 2/19/2020

State auditors, in a report Wednesday on Medicaid transportation, shredded the performance of the state’s vendor, Veyo, which is paid more than $160 million over three years upfront, before even providing a single cab or van ride to the thousands of people who comprise the state’s poorest, sickest patients, including children with cancer.

By extension, the audit of California-based Veyo impugns the work of Department of Social Services, the state agency that is supposed to be monitoring Veyo’s work. The company began here in January 2018.

Children’s lawyers, nurses and hospital officials have testified at legislative public hearings that this is high-stakes work and mistakes can harm patients.

The auditors said they found that a patient undergoing chemotherapy waited five hours beyond their scheduled pickup time for a trip home. Staff at the medical center heard the patient’s spouse “contacting Veyo 5 times asking where the ride was, and was told 5 times that the ride was on the way," the auditors wrote.

“The facility verified the 5 calls by viewing the spouse’s cell phone records," they wrote. “When the facility subsequently called Veyo on behalf of the patient, Veyo told a facility employee that the member cancelled the ride, and that Veyo had no record of the calls.”

Another patient required wheelchair transportation to dialysis treatment. The clinic reported that Veyo frequently sent transportation that could not accommodate a wheelchair.

As they investigated, the auditors found Veyo “repeatedly failed to send the correct mode of transportation” and that Veyo attributed the failure to “incorrect information.” Of the 70 trips scheduled for the patient in January 2019, Veyo recorded 30 of 61 dialysis appointments as removed, cancelled or deleted, the auditors said.

In its response, Veyo said it “highly regrets the errors that appear to have been made in these incidents. … While an extremely small percentage of trips contain data errors, Veyo acknowledges that correcting trip information can still be subject to human error and is constantly refining it training, technology, and communication to reduce error rates.”

While the auditors said DSS should monitor Veyo’s trips more closely, the Department of Social of Social Services said it “neither agrees nor disagrees with this recommendation. DSS will undertake its own review of the data reviewed by the auditors and will take appropriate action to ensure the accurate reporting of data.”

Advocates said the audit confirms what they have been telling lawmakers and complaining about to DSS.

“The results underscore everything that we have been saying from the onset of the contract -- Veyo provided data inconsistent with patient and provider experience,” said lawyer Bonnie Roswig of the Center for Children’s Advocacy in Hartford.

”Patients are missing critical medical appointments and health care providers are spending endless hours trying to get transportation for their patients,” Roswig said. “We have been telling DSS about the issues from the very beginning and they have failed to use the contractual remedies.”

Veyo's three-year contract expires in June.

“The timing of the audit is perfect,” said state Rep. Cathie Abercrombie, a Meriden Democrat who is co-chair of the legislature’s human services committee. "My hope is that DSS, with its ability to amend an agreement with Veyo or ask for new requests for proposals, takes these findings into consideration. This is what we have been complaining about for some time, and DSS has acknowledged there are flaws with Veyo’s data.”

In January 2019, Connecticut Legal Services in Middletown filed a $33 million, federal class action lawsuit against the Department of Social Services and Veyo, saying an unending stream of canceled rides and stranded patients have made a vulnerable Medicaid population even sicker and is endangering lives in some cases.

After five settlement conferences, the lawsuit remains active.

In a statement, Veyo officials said while “we wholeheartedly support and endorse the majority of the recommendations, we also feel that it is imperative for us to raise concerns with certain portions of the audit report. In particular, we disagree with some of the findings [which] were based on incorrect assumptions or misunderstanding of the facts.”

The company said patients “travel over 40 million miles on Connecticut roadways each year ... with thousands of different drivers and an incident rate of just 0.005 percent. While any safety incident is highly regrettable, Veyo acknowledges that with such a large volume of trips (nearly 2 million ambulatory and wheelchair trips per year), it’s very difficult to avoid a small number of incidents.” Veyo said the errors should be viewed as isolated incidents.

The audit, by the independent, bipartisan Auditors of Public Accounts found Veyo was slow in some instances to respond to dangerous situations, such as unsafe drivers.

One or more patients “complained to Veyo about drivers and their vehicles smelling of marijuana, and in no instances did Veyo immediately remove the drivers,” the auditors said.

In at least five other instances, patients complained about “reckless driving and patients reporting not feeling safe. For example, one member reported fearing for his safety when the driver traveled 80 miles per hour in a 50 mile per hour zone. Veyo substantiated the complaint, but did not immediately remove the driver."

The audit also called out Veyo and DSS for mishandling fundamental tasks and responsibilities.

For example, nearly eight of 10 patients had to seek out medical necessity forms from their doctors and nurses “to override decisions” Veyo made about the type of transportation the patients received -- a wheelchair van versus a Toyota sedan, for example -- or whether other passengers can ride with a patient, such as a child with an immune deficiency.

The auditors found that Veyo “does not record all complaints, accurately substantiate certain complaints, or promptly resolve complaints.”

“Veyo has a financial incentive to substantiate as few complaints as possible,” the auditors said. “Out of the 10,054 complaints filed from January 2018 through June 2019, Veyo substantiated 56 percent and did not substantiate 44 percent.

“Based on the investigative evidence, it is unclear why Veyo did not substantiate certain complaints. We found examples of complaints that Veyo improperly deemed unsubstantiated."

Auditors said DSS rarely imposed sanctions for the times Veyo failed to meet its “contractual performance standards.”

The unreliability of some of Veyo’s data has frustrated lawmakers, patient advocates and health care providers. The auditors said they have determined why. They said Veyo “changes statistics, sometimes retroactively, without explanation in its monthly reports to DSS, including its calculation of percent of on-time trips, which raises concerns about the accuracy of some of the reported information.

“We found that Veyo changed the data to show more positive results. ... Veyo should explain any changes in on-time trip percentage calculations in its monthly reports so that readers are informed and understand the reasons for the changes."

The auditors found Veyo has frequently dispatched vans, cabs and Uber-style cars operated by independent drivers on what amounts to phantom trips -- locations of patients who have canceled their rides and no longer want or need the service.

“These trips are no longer necessary due to a change of address, medical condition, or appointment day or time," the auditors wrote. “A transportation provider informed us that in order to stop being assigned the trip, Veyo required the company to accept the incorrect trips four times and mark the patient as a no-show all four times.”

Veyo was still paid upfront for all of the phantom rides.

Josh Kovner can be reached at jkovner@courant.com.

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