In July 2009 Logisticare Solutions LLC began managing non-emergency medical transport services for Medicaid patients in New Jersey. In other words Logisticare LLC provides a broker program to manage the medical transportation services. Before LogistiCare stepped into its new role, eligible people who needed help getting to medical appointments could directly contact one of scores of independent, certified local companies that contracted with the state Department of Human Services to provide these services. Now, clients call LogistiCare's central office in Edison, where dispatchers assign rides statewide.
Prior to the broker program, the clients/patients determined who and what company would provide the transportation to and from their doctors. Depending on the quality of the service provided, clients would choose which transportation provider company they want to be serviced by. After the introduction of the broker program, Logisticare gets the final word and decision on which transportation providers get the jobs. Each client is very important to every single transportation company because each client represents a job.
When the idea of a broker program was first introduced to the transportation provider companies they were told that they would retain the SAME VOLUME OF JOBS THAT THEY HAVE ALWAYS HAD. THAT WAS A LIE!! Not one owner of any transportation company in the state would sign the contract if they knew that their work volume would substantially decrease. Why would people who spent years building a successful business leave their company's well being in the hands of an outside company they never heard of ? Answer, because they were flat out LIED TO.
Not only has Logisticare decreased the amount of jobs Transportation Providers receive, but they also reduced the amount they get paid per each trip. While at the same time astronomically increasing insurance costs and also the costs to process the billing of these trips. They also introduced many costly and useless regulations. That is why many Transportation Companies in the State of New Jersey went out of business.
Nobody even knows how Logisticare LLC got the NJ State contract to manage the medical transportation services. Usually there is a bidding war for these contracts. No bidding war took place, Logisticare just magically got the contract overnight? Now that is interesting.
WE DO KNOW THAT HIRING LOGISTICARE IS COSTING THE STATE $300,000,000.00+ according to their contract with the state. As soon as Logisticare got the contract they made an ultimatum to all of the transportation providers. The ultimatum was to sign and agree to the terms and conditions of their contract OR ELSE THEY (the transportation providers) WILL NO LONGER BE ABLE TO DO BUSINESS IN THE STATE.
Let us take a look at some of the statistics which were reported by a survey conducted in 2010 by THE MEDICAL TRANSPORTATION ASSOCIATION OF NEW JERSEY. Every transportation provider company is a member of The Medical Transportation Association of New Jersey (MTANJ).
The survey question topics were drawn from over a year of MTANJ member experience with the broker system (Logisticare System). Survey was conducted with responses from 27 transportation providers. The most defining response indicative of the difficulties associated with the broker program is that - IF THEY HAD A CHOICE - 89% OF COMPANIES WOULD NOT PROVIDE TRANSPORTATION TO MEDICAID ENROLLEES UNDER THE BROKER SYSTEM.
- The average cost per respondent to prepare the the implementation of the broker system was $31,838.00
- Monthly operating costs have increased more than $4,000.00 for 26% of respondents - just to process Logisticare's paperwork and claims
- 67% of responding companies must submit the same compliance information to Logisticare 3 or more times
- Logisticare acknowledges receipt of information sent to them only 10% of the time
- 95% of companies must re-submit clean claims multiple times at least some of the time
- 85% of companies have had claims denied because of incorrect compliance information in Logisticare's system
- 80% of respondents say that it takes more time to schedule a trip now than before the broker program
Combined with the inadequate reimbursement for ambulance and MAV trips provided to Medicaid recipients and the problems associated with the current Logisticare Broker System, any additional costs are excessive. The cost to process paperwork and claims identified in the survey does not include less easily quantified costs incurred by management, supervisors, intake and dispatch personnel dealing with the broker system process.
From the beginning of the implantation period for the broker system, the MTANJ supported the compliance requirements as a whole, particularly those required for employees. That is not the issue. What has been brought up numerous time since then is Logisticare's record-keeping of vehicle and employee compliance information.
91% of transportation providers never received acknowledgment that their records have been received or find out when they take more of their time to confirm with Logisticare. Logisticare's payment of claims is tied to their having the correct compliance records. Logisticare's provider agreement states that "No payments will be made for services performed by non-compliant drivers or vehicles that not registered with LGTC to provide services" Logisticare relies on its compliance system to check that provider information is current before paying claims. 85% of providers responded that clean claims are being denied due to incorrect compliance information in Logisticare's system. The RFP for the broker services permits denial of clean claims but does not specify whether denial due to broker responsibility is acceptable.
PROVIDER EXPERIENCES LEAD TO ONE CONCLUSION: LOGISTICARE'S TECHNOLOGY AND SYSTEMS DO NOT SEEM TO BE SUFFICIENTLY ADVANCED TO HANDLE THE DOCUMENTATION REQUIREMENTS. As a result, New Jersey providers spend hours duplicating their efforts in order to be compliant to ensure they will be paid.
Logisticare's billing system requires double entry and at times manual re-entry. In comparison to the Medicare electronic billing system and those of virtually every other player, LOGISTICARE'S BILLING SYSTEM IS LABOR INTENSIVE AND OUT-OF-DATE.
As with compliance records, claims must be faxed to Logisticare multiple times. The connection between incorrect compliance record-keeping by Logisticare affects claims payments due to related denials. The difficulties of the system add to administrative costs.
100% of the companies surveyed have experienced client complaints about not getting them as their preferred provider even when the provider is available. Trip rerouting appears arbitrary. Transportation Providers have seen their volume decrease sometimes to alarming levels even as they see companies from out of the service area routed trips for which they stand ready and waiting. Some providers are so busy they are buying additional vehicles while others in the same area re watching their years of building a business waste away through no fault of their own.
When Logisticare assigns a trip to a provider that the provider cannot take (because it is, for example, scheduled after hours, added on at the last minute when a driver or vehicle is no longer available, or is miles out of the provider's service area) there is another unnecessarily labor-intensive process that providers must follow to re-route the trip. Logisticare has assigned the incorrect LOS to almost half of all providers.
Transportation Providers are subject to payment of "liquidated damages" if they reroute more then 15% of assigned trips or if the trip is not re-routed within the time frame specified in the provider agreement. While Logisticare has not totally enforced these terms, providers remain subject to them and subject also to Logisticare systems and practices that put them at risk. Furthermore, due to the reductions in trip numbers assigned to some providers, they are forced to accept Ambulatory MAV trips just to keep their employees working.
** THE SURVEY DOES NOT ACCOUNT FOR ALL PROBLEMS PROVIDERS ARE EXPERIENCING WITH LOGISTICARE **
Here are some comments from the Transportation Providers that were surveyed. Identifying information was removed at their request to prevent repressions from Logisticare.
** "When Logisitcare began expediting clients to providers, [we were] informed that as long as clients requested [us] we would retain our clientele base. Logisticare asked us for a list of our clients and we provided the name, patient's information, Medicaid Number, and the physician's information for our entire clientele base. We game them a list of over 70 clients that took over 11 years of our hard work to build.
The reality has been that although clients would request [our company] as their preferred provider, Logisticare would routinely route them to other providers (brand new companies out of county) and inform them that we are busy when in fact our vehicles are parked without work. We have lost so much business that [we] had to let a driver go after 5 years of employment, and removed a vehicle from operation.
Some of the individuals that we are now being assigned are not even in the county that we informed Logisticare that we work out of, but, are forced to transport for lack of business. We are taking just about half the number of patients we used to do before Logisticare. We ask them for 3 times as many trips as they are sending us. Needles to say, the effect of this loss of business has [our company] on the verge of bankruptcy."
** "Yes very much indeed. The last minute introduction of a trip and their inflexibility to admit that they did it unethically. The constant difficulties of communicating via telephone and the un-rapid response by their staff to the providers. Errors by them are not to be contested but what Logisticare considers and error by the provider they are down right nasty and viscous to us especially the small companies like us. I have 3 to 4 times a week nightmares about them."
** "Duplicate providers for same trip, no notification of canceled trips, bad appointment addresses, wrong appointment time."
** "Billing programs slow and unpredictable, continued denials after issue supposedly resolved, lack of integration with in-house billing systems, changes made which are onerous regarding compliance, lack of support for Logisticare's own policies regarding provider's responsibility on transports, poor education provided by Logisticare about services and process."
** "Assist charges are often denied several times even though Logisticare has approved them; patient signatures are often denied because they are slightly above the line and/or their signature is too small; upper management does not return phone calls; trips that are rerouted by [us] are often put back onto our manifest and have to be rerouted again; Logisticare will call and ask [us] to do a trip; [we] refuse the trip but Logisticare adds the trip onto the manifest anyway."
** "They do not follow the contract; reject trips for no reason; verbally advise us on a procedure then retract any knowledge of it later on; use every excuse not to pay for trips."
** "Patients that prefer other providers continuously appear on our manifest. If we do not show for that patient, they hold it against us. We send a vehicle out to the patient and constantly what the patient get into the vehicle of their preferred provider and we do not receive reimbursement for that trip."
** "It is very hard to deal with Logisticare. Double booking trips; booking the same trip with two or more transportation providers; putting the same trips twice or more in the same day schedule; they underestimated the mileage for our trips not considering any kind of detour or reroute."
** "Our company is not happy at all with Logisticare. For reason that we spent more money and less income. We don't like it but we don't have other options. Logisticare was forced on us, it is not like we were given any option. If we were, we would be taking advantage of that."
** "The 20% decrease in MAV is unacceptable. We now have higher compliance costs and additional staff costs, but our revenue has decreased. It sometimes takes longer to assist an elderly MAV client than to actually transport a wheelchair client."
** "There is no place to formally lodge a complaint against Logisticare. They however send threatening letters to the providers without investigating. They copy the patients on the letters.
When a complaint is rebutted, Logisticare does not follow up with the provider. There is no feedback informing the provider whether or not the complaint stands.
It takes 3-4 phone calls to get a supervisor on the line. None of the call intake personnel are able to list their chain of command.
The intake personnel will only assist with 3 patients at a time. They state "I can't stay on the line with you all day." This is as backed by the supervisor."
** In America, there is no business model that does not allow for the owner/ proprietor to have total autonomy on building/increasing sales, except in the state of New Jersey as a Logisticare Invalid Coach provider. We have no say on how many clients we want to transport, where we want to transport, our hours of operation, and the option of same day service.
The tenet of providing an effective, efficient, and productive service to invalid individuals in the state of New Jersey must be in line with physician's Hippocratic Oath: to uphold professional standards, and to help those who are seeking help, even if it is same day service; which no longer exists. We have no say in our business anymore and Logisticare will quickly remind the provider that they are no longer your client they are Logisticare's clients. This purposeful disconnect of provider to patient prevents the necessary rapport and quality of care for the patients of New Jersey it is wrong and unproductive.
Finally, we believe that if the State compares the Unisys provider's claim to the Logisticare's system and a proper audit and paper trail was initiated, we are certain that grounds for Logisticare's system would be, at best, dismissed."
*** FOR ANYONE WHO WOULD LIKE TO COMMENT AND CLAIM THAT ANYTHING IN THIS REPORT IS FALSE, PLEASE REMEMBER THAT PROVIDERS ARE WILLING TO STAND IN THE COURT OF LAW AND TESTIFY THEIR CLAIMS AGAINST LOGISTICARE UNDER OATH. MANY CLIENTS/PATIENTS ARE ALSO WILLING TO TESTIFY UNDER OATH. CLIENTS EVEN HAVE HAND WRITTEN ACCOUNTS OF THEIR GRIEVANCES TOWARDS LOGISTICARE, SIGNED AND DATED. ***