When new employees start at SafeRide Health, they learn all about our mission: Ensuring that every health plan member can access the care they need. They learn that our services are often a crucial part of someone’s healthcare journey: More than 60% of members use our transportation services to get to life-sustaining care. They also receive required training in healthcare privacy laws as well as fraud, waste, and abuse (FWA).  

What is FWA? It encompasses a wide range of wasteful and even illegal practices that cost the healthcare industry billions of dollars every year. Some healthcare waste is unintentional or simply excessive, such as prescribing tests that aren’t really needed or expensive medications that aren’t proven to work as prescribed. Other types of FWA can result in fines or prosecution, such as providers who charge health plans for services they didn’t perform or for prescribing drugs for illegal purposes.  

Across the whole healthcare industry, it’s estimated that about 25% of U.S. healthcare spending is wasteful and 3-10% is due to fraudulent and abusive billing. The total cost of healthcare waste is estimated between $760 billion to $935 billion.  

Fraud, Waste, Abuse and Non-Emergency Medical Transportation

In the non-emergency medical transportation (NEMT) industry, a wasteful practice might be sending a costly, stretcher-equipped vehicle for someone who has said they can walk to the curb by themselves. Fraud and abuse can be a transportation provider who bills for rides that never took place, a member who claims they took a ride for a covered service when they were going someplace else, or someone who goes to a pharmacy without a prescription on file.    

SafeRide Health believes it’s important to help identify suspected cases of FWA, because those wasteful or fraudulent practices drive up the cost of healthcare for everyone, diverting important resources from the people who need them the most.  

SafeRide collects extensive data about every ride that our transportation partners provide, and these rich insights are accessible quickly so we can take meaningful action when needed. Some of those data points and performance metrics include:  

• Was the ride fulfilled (did it happen)?  

• Was it on time?  

• How long did the ride take?  

• What kind of vehicle was used?  

• How much did it cost?  

• Did the member go to an approved location?  

• How did the member rate the ride afterward?  

We collect and analyze the information to not only ensure that members are getting the best service possible, but our internal FWA Prevention & Control team also uses the data to proactively and quickly identify any questionable activity and work to prevent FWA from happening in the future. Transportation brokers that don’t collect the same data are left without the necessary tools to identify FWA and prevent it from happening in the first place.  

Empowering Member Self-Service Across Modalities While Controlling FWA

Across the healthcare industry, providers are looking for ways to give health plan members the tools to manage their own care when appropriate and desired. SafeRide is no different, offering members the ability to schedule their own rides, track their benefits, and more with our member portal.  

That’s also the case with gas mileage reimbursement (GMR) and/or individual transportation programs (ITPs), an option for some Medicaid plan members who drive themselves to appointments or have a trusted friend or relative drive them. With SafeRide, members and drivers can register and request reimbursement through an easy-to-use online portal, with built-in eligibility guardrails to help prevent FWA.  

Controlling fraud, waste, and abuse within GMR initiatives has been a challenge for health plans and NEMT brokers, but SafeRide has seen success with its fully digitized and closely monitored GMR program. In fact, we’ve helped one health plan reduce costs by about $60,000 over four months by reducing fraudulent GMR rides.  

We know it’s important to educate not only our employees but also our transportation providers about what constitutes FWA and what they can do if they suspect wasteful or fraudulent practices. If SafeRide validates any suspected FWA, we report it to the health plan’s Special Investigations Unit to ensure we are following all state and federal regulations. Together, we can help bring down costs and ensure that members who truly need their transportation benefit are getting the best service possible.

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