{"id":437113,"date":"2026-01-29T15:50:09","date_gmt":"2026-01-29T15:50:09","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/437113\/"},"modified":"2026-01-29T15:50:09","modified_gmt":"2026-01-29T15:50:09","slug":"colorado-medicaid-program-mistakenly-paid-providers-10-times-too-much","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/437113\/","title":{"rendered":"Colorado Medicaid program mistakenly paid providers 10 times too much"},"content":{"rendered":"

In November, Colorado Medicaid officials corrected a mistake.<\/p>\n

Five years earlier, they\u2019d told contracted transportation providers in metro Denver to bill the state as if the providers were specialty ambulances. By 2022, those providers were billing the state for more than $640 for every pick-up. By 2025, the rate increased more, to nearly $669.<\/p>\n

In reality, the pick-ups should have cost $65, legislative staff told lawmakers Tuesday.<\/p>\n

\u201cThis just seems like \u2014 what?\u201d said Sen. Judy Amabile, a Boulder Democrat, citing the final difference: \u201cWe paid 10 times what we were supposed to pay?\u201d<\/p>\n

It\u2019s unclear how much the incorrect billing guidance has cost the state\u2019s Medicaid program. But the analyst told lawmakers on the Joint Budget Committee that the fixed billing error would save $60.5 million in the 2026-27 fiscal year, of which $18.2 million would\u2019ve come from the state\u2019s primary \u2014 and cash-strapped \u2014 spending account.<\/p>\n

Fixing the error in November was projected to save nearly $33 million in the current fiscal year, which ends June 30.<\/p>\n

Lawmakers were incredulous.<\/p>\n

\u201cYou either laugh at this one, or you cry,\u201d said Rep. Kyle Brown, another Democrat on the budget committee. \u201d \u2026 So maybe it\u2019s $20 million in a given year, and it\u2019s been going on since 2020. That\u2019s a lot of money.\u201d<\/p>\n

Legislative staff described the billing discrepancy as a mistake. The Denver Post asked Marc Williams, the spokesman for the Department of Health Care Policy and Financing<\/a>, for comment for this story early Wednesday afternoon. In a statement provided just before 8 p.m., Williams seemed to contradict legislative staff by casting the initial change as an intentional choice, made to accommodate the special requirements of transporting patients who use larger wheelchairs.<\/p>\n

\u201cBecause of the additional staffing and equipment, the Department provided guidance in 2020 that providers could use the \u2018specialty ambulance service\u2019 billing code when XL Wheelchair services were needed,\u201d Williams wrote.<\/p>\n

At the time, he said, \u201cthe cost per pick-up for specialty ambulance services was $232.44.\u201d But just a couple years later, the rate nearly tripled \u201cto better align with Medicare.\u201d<\/p>\n

He said the department was evaluating how much the higher billing code cost the state, and he said the department established lower rates \u2014 $34 for pick-ups with one attendant and $65 pick-ups for those with two, plus mileage \u2014 late last year.<\/p>\n

How overpayments happened<\/p>\n

According to a JBC staff report presented to the committee<\/a> this week, Medicaid officials were concerned in 2020 that metro transportation providers were confused about which billing code to use. The companies provide rides to medical appointments for Medicaid members at no cost to the patients, and in a nine-county region around Denver, they\u2019re coordinated by a broker.<\/p>\n

Medicaid officials told the broker \u2014 who then told the companies \u2014 to use a billing code intended for specialty ambulances.<\/p>\n

The mistake persisted for years, even after Medicaid officials identified a separate problem within the transportation program. In 2023, as The Post has reported, officials learned that a coordinated \u2014 and international \u2014 fraud scheme targeted a different part of the transportation program, bilking Medicaid out of $25 million<\/a>, according to a recently released estimate.<\/p>\n

Legislative staff asked Medicaid officials why they \u201cdidn\u2019t catch the error for five years,\u201d according to the report. The health care policy department, which oversees Medicaid and goes by HCPF, replied that they hadn\u2019t noticed it earlier in part because they were focused on the fraud scheme \u2014 which was identified roughly three years after the billing guidance was released.<\/p>\n

\u201cIn the midst of the chaos caused by the fraud event in the fall of 2023, and HCPF\u2019s implementation of the numerous changes to the program in response, reviews of program details such as this did not happen until 2025,\u201d the department explained, according to the legislative report. \u201cThis aspect of the program had not been specified in published policy and so the issue was not immediately apparent.\u201d<\/p>\n

Nor had a Medicaid rate advisory panel noticed the discrepancy in 2024, when it conducted a review of Medicaid billing codes.<\/p>\n

\"ColoradoColorado state Rep. Emily Sirota, right, speaks as Sen. Judy Amabile listens during a Joint Budget Committee hearing at the Legislative Services Building in Denver on Thursday, Dec. 19, 2024. (Photo by AAron Ontiveroz\/The Denver Post)<\/p>\n

Rep. Emily Sirota, a Denver Democrat who\u2019s the budget committee\u2019s chair, asked why the panel hadn\u2019t picked up on the \u201cabsurd\u201d difference between what was being paid versus what should\u2019ve been paid. (The panel, which is under HCPF, did not return an email seeking comment Wednesday afternoon.)<\/p>\n

A legislative analyst replied that the panel didn\u2019t notice any problems with patients accessing the service and determined it was fine.<\/p>\n

\u201cCool,\u201d Sirota replied dryly. \u201c\u2026 I just don\u2019t understand how this could\u2019ve gone so unnoticed for so long.\u201d<\/p>\n

Williams, the Medicaid spokesman, said that there was low utilization of the higher-rate billing code until 2023, when it \u201cstarted to spike\u201d \u2014 after the rate had increased sharply. Still, he said it took the department two more years to identify the increase and \u201cthe associated cost growth.\u201d<\/p>\n

Can state claw back money?<\/p>\n

The money that was set to be spent on unnecessary wheelchair transport billing this year alone was more than double the amount lost in the separate fraud scheme, according to the legislative analysis. Because providers were following instructions from HCPF, which oversees Medicaid, the excess money can\u2019t be clawed back or pursued, legislative staff told lawmakers Tuesday.<\/p>\n

Adela Flores-Brennan,\u00a0the director of Colorado Medicaid, confirmed to a separate legislative committee Wednesday that the state would not try to get the money back from providers.<\/p>\n

But on Wednesday evening, Williams wrote that HCPF would investigate whether \u201cupcoding has taken place\u201d among some providers and \u201cevaluate outlier provider billings for further action, including post payment reviews and payment recoupments.\u201d<\/p>\n

Lawmakers raised another concern Tuesday: Would the federal government, which jointly funds Medicaid, try to retrieve some of the money? The question, from Amabile, was greeted with brief silence and then a wave of nervous laughter.<\/p>\n

\u201cI don\u2019t know,\u201d replied Eric Kurtz, the JBC analyst.<\/p>\n

\u201cThis is a huge mess-up on their part,\u201d Brown said of HCPF. \u201cI don\u2019t know what to do about this, exactly, other than the fact that they probably need to correct it in some meaningful way.\u201d<\/p>\n

HCPF told the budget committee\u2019s staff that it was already conducting an analysis of the transportation program with an outside contractor, who has \u201cprovided further recommendations to the Department on areas of cost savings for the (non-emergency medical transport) program and rates.\u201d<\/p>\n

Now, legislators have to figure out how much HCPF should be paying for pick-ups in the large wheelchair program. While the metro Denver providers were getting the $669 reimbursement, providers elsewhere were largely receiving the $65 payments.<\/p>\n

Legislative staff and HCPF recommended that lawmakers just pay everyone the $65 rate. But some lawmakers said they\u2019d already heard from metro providers who wanted more than $65.<\/p>\n

\u201cI would like to have additional information before we decide to vote on it,\u201d Sen. Barbara Kirkmeyer, a Brighton Republican, said. She noted that the vehicles for the program needed to have lifts to load the Medicaid members\u2019 larger wheelchairs.<\/p>\n

The legislators instead directed staff to summon HCPF for a future hearing to provide more information about how they should proceed.<\/p>\n

Stay up-to-date with Colorado Politics by signing up for our weekly newsletter, The Spot.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"In November, Colorado Medicaid officials corrected a mistake. Five years earlier, they\u2019d told contracted transportation providers in metro…\n","protected":false},"author":2,"featured_media":437114,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[206535,97,252,253,1341],"class_list":{"0":"post-437113","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-bureaucratic-error","9":"tag-health","10":"tag-health-care","11":"tag-healthcare","12":"tag-medicaid"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/437113","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=437113"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/437113\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/437114"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=437113"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=437113"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=437113"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}