Patients, advocates say MaineCare transportation company is failing to live up to its agreement

A transportation broker company with a pending contract to handle all MaineCare rides throughout the state is facing complaints from vulnerable riders who say they’re being left at their appointments and declined for rides without receiving the required documentation giving the reason.

Laur Laughlin, who lives in Sanford, struggles with autism and ADHD. She recently secured housing after being homeless for a year. To access medical appointments, she was referred to Modivcare, an Atlanta-based corporation contracted to provide transportation to MaineCare recipients in half of Maine’s 16 counties.

Laughlin requested a ride to a medical appointment in March, which was denied. Out of the five rides she requested in the past six months, Laughlin said she’s only made it to one appointment through Modivcare. She didn’t receive a call or communication about her ride when the appointment ended. Then a driver arrived an hour late to pick her up.

“I've been having some medical issues with losing consciousness and falling, which is still unresolved, mostly because I've been having some issues with getting to those appointments,” Laughlin said. “That has obviously affected me mentally … not being able to get access to the services I need.”

Modivcare is contracted by the state to arrange rides in Aroostook, Hancock, Washington, Androscoggin, Franklin, Cumberland, Oxford and York counties.

The company, valued at over $300 million, is the largest non-emergency medical transportation broker in the nation, operating in 20 states, including Maine.

Modivcare, which operates under a $5.6 million contract with Maine, was approved last year to service every county in the state. The statewide contract, which was supposed to begin in July and is estimated to be worth up to $750 million over the next decade, hasn’t been finalized because two other companies challenged the state’s decision in court , claiming the award process was flawed and unfair.

The current contracts — which split regions with Penquis Transportation and Waldo Community Action Partners — have been extended through the end of the year.

“We are contesting that and stand firm that this decision should be overturned,” said Kara Hay, the president and CEO of Penquis.

Angela Fochesato is the director of the Beth C. Wright Cancer Resource Center, a nonprofit that provides wraparound services for cancer patients in Maine. One of the biggest barriers cancer patients face in the state is access to treatment, said Fochesato, because they may not have the financial resources to make it, or driving can be too cumbersome in their condition.

Fochesato, who works in Ellsworth, said she’s made 100 trips to Bangor to pick up patients stranded after their treatments.

“The patient calls and says, ‘I'm still waiting, no one's picked me up yet.’ Or they'll get them there and they leave them at cancer care … (patients) call and say ‘It's 5:30, they're closing up the (cancer treatment) center and my ride's not here. What am I going to do?’ ” Fochesato said.

In coordination for a scheduled cancer surgery, a patient told Fochesato that a representative asked the patient to walk to surgery.

“Why would you even ask them to walk?” Fochesato asked.

Other times, the resource center arranges hotel stays or covers the cost of a taxi home, which can be $600 one way.

Myra Orifice, senior director of operations for Modivcare in Maine, said complaints are handled with the Office of MaineCare Services as well as internal company procedures. But national health privacy protections make it difficult to obtain specific complaint information, so she said she could not address specific instances.

“If I ever heard of one of my (drivers) telling a member to walk, that's what they would be doing,” Orifice said.

Fochesato, of the Beth C. Wright Center, has documented the issues with Modivcare and said there’s been so many, she has “a whole book of them.” She said she’s raised the issue to the offices of Senators Susan Collins and Angus King.

“This is unacceptable,” said Fochesato. “At least (Modivcare is) attempting to do something, but there's a lot of room for improvement if anybody wants to sit down and talk about it.”

Who’s your driver?

Modivcare operates its own vehicles around the state as well as contracting with other companies to provide rides. Many of Modivcare’s subcontractors in Maine are limited liability companies that do not provide websites or information on their drivers.

One of those companies, Safe Transit LLC, is a New Hampshire-based limited liability company. The company is registered to conduct business in Maine but is labeled as “not in good standing” to conduct business in its home state, and the business filings in both states list the same Portland-area phone number.

Orifice said the company is operating for Modivcare, and she wasn’t aware it isn’t in good standing in the state it was established. Attempts to reach the phone number and agent listed with the company were not returned.

Delores “Deedee” Garcia, a 68-year-old who lives in Alfred, spent her career as a union worker in California. She’s now retired and receives low-income health insurance. She is disabled and struggles with fibromyalgia, mobility issues and PTSD.

She’s entitled to rides under Modivcare but doesn’t feel safe with them anymore. She feels they don’t provide enough information on the driver who will pick her up, among other reasons.

In October 2023, Garcia told The Monitor, she received a ride from Safe Transit LLC to a dentist appointment in New Hampshire. Her driver, who was late picking her up, was driving 90 miles an hour on the highway. She texted the local police for a traffic stop but wasn’t able to get help.

“I've never been so terrified in my life,” Garcia said. “I don't want to use them anymore.”

Garcia has filed complaints with Modivcare and her own insurance company over the incident. She spent weeks without a response or acknowledgment that her complaint was received. She told a call center representative that she would file a police report against the driver, and believes that was the only reason she received any communication about her complaint.

“That's not the kind of person I want working with the members,” said Orifice who added the driver was fired but the contracted company remains active.

Maine DHHS guidelines say third-party drivers like Uber and Lyft can pick up medical rides in ‘certain cases.’ Modivcare claims that in 2023, “half of one percent (0.5%) of Modivcare’s scheduled trips in Maine were fulfilled by Transportation Network Companies” such as Uber and Lyft.

The Department of Health and Human Services said in an email that they are “committed to providing safe, reliable and high-quality transportation to MaineCare members that helps them to meet their health care needs,” and complaints should be “filed directly to their NET broker, by calling MaineCare Member Services, or by contacting DHHS staff directly.”

Rides denied

The company’s agreement with the state says it is required to provide members with a formal notification letter describing the reasoning behind any declined ride.

Laughlin told The Maine Monitor that she has not received any explanation why her trips were denied.

“They did not give me a reason. When I called they were just like, ‘It's been denied, you did not fill out the documentation appropriately,’ ” Laughlin said. “Which is really upsetting, considering the first time they filled out the documentation with us over the phone.”

The state’s Office of MaineCare Services directs members to refer questions to the broker entity . But Laughlin said Modivcare is rarely available for questions and she often waits up to an hour and a half when trying to reach a representative on the phone.

“The attempts at reaching them were complicated,” Laughlin said. “These people have been messing with my life, and I would like something to happen.”

The company paints a different picture, and in a recent press release stated that Modivcare has maintained “exceptionally low levels of member complaints and vehicle unavailability, both of which are consistently below 0.1%.”

The company says it is on time roughly 94 percent of the time and fewer than 1 percent of scheduled rides are denied. Trips are denied for a range of reasons, said Orifice, the most frequent being that a patient did not give a required two-day notice for non-urgent trips.

“In 2023, less than 5,000 member trip requests in Maine were denied, accounting for 0.4% of all scheduled trips,” said Orifice. “Each denial is tracked meticulously for a specific, pre-defined reason and reported to the state as per our contractual obligations.”

The Department of Health and Human Services and Modivcare did not provide documentation to support these figures.

The Department of Health and Human Services said in an email that they are “committed to providing safe, reliable and high-quality transportation to MaineCare members that helps them to meet their health care needs,” and that complaints should be “filed directly to their NET broker, by calling MaineCare Member Services, or by contacting DHHS staff directly.”

Several Modivcare users, however, said they were stranded or never picked up for numerous appointments and not given a reason. The company’s Better Business Bureau profile has an F rating and 452 complaints on its site in the last three years.

Sam Small is the owner of RideSource in Norway, a subcontractor for Modivcare. He feels the work his company and Modivcare contribute is important but there could always be room for improvement.

Small said most rides are picked up electronically at the discretion of the subcontractors. The more complicated appointments, typically required for patients with the highest need for care like medical testing or observation, are categorized as “will call” rides.

They might only require a driver to take a patient to an appointment, and the return trip will have to be picked up by another contractor who wants to take it, a process he calls “unfortunate” that the most vulnerable riders may have to wait longer than others for a pickup.

In this arrangement, patients can be left without a ride home.

“I am aware that it happens,” Small said. “We use (our) resources to the best of our abilities to make sure that people don't get stranded. But again, in the end that responsibility really falls back to Modivcare.”

Nationwide, Modivcare and its subcontractors have also faced allegations of fraud for overbilling Medicare and Medicaid. In Ohio last year, the company agreed to pay $3.75 million to the federal government and the state in a settlement over submitting false claims for payment to Medicaid and Medicare spanning over a decade .

In Florida, where Modivcare is contracted as the sole brokerage company, the state’s health care administration agency received 2,309 complaints from 2017 to 2021. Last year nearly 20 employees of Sweet Transportation LLC, a Modivcare-contracted company, were arrested and accused of fraud, racketeering, and money laundering for billing Medicaid millions of dollars in trips they did not complete.

Laughlin has nearly given up on the program. Instead she has made a time-intensive plan to take a bus from Sanford to Portland to stay with her father for the weekend, and then a bus to her appointments, despite her medical concerns.

“They are definitely my worst experience involving medical care whatsoever,” Laughlin said.

She feels the company is not living up to its stated purpose of removing barriers to medical care for the most vulnerable.

“Not even close,” Laughlin said.