By: Dan Reid, President/Managing Member, Grove Transit For you non-Val Kilmer fans or others too young to get the reference in the title, I refer you to The Saint , circa 1997.  However, in this article I plan to show you that our “cold fusion” is not a hypothetical energy source, and I will explain exactly how the seemingly impossible is, in fact, true - you can pay higher rates to high-quality NEMT providers while at the same time reducing the total cost of delivering quality NEMT services . How, you ask, can these seemingly contradictory statements both be true?  The secret lies right there the statement itself “high quality NEMT providers” and “total cost of delivering quality NEMT services”. First let’s look at the current environment we are operating in and set the field for everyone.   Oversight of NEMT programs has expanded significantly as regulators seek to improve program integrity while safeguarding access to care. Today, brokers and health plans are likely to face multiple audits per year, particularly when operating in multi-state or multi-region environments.  OIG audits have always been a prominent source of scrutiny, often focusing on documentation integrity, provider oversight practices, and data anomalies that may indicate fraud or abuse, however, these days investigations by State Attorneys General are more common, using audit findings and irregularities as the basis for broader investigations and indictments, as seen in states such as New York and Minnesota. While these audits focus on entities responsible for contracting and payment, the deficiencies identified during these audits and investigations often originate at the NEMT provider level. Documentation gaps, inconsistent credentialing practices, data integrity issues, and weak internal controls can expose brokers, health plans, and agencies to significant compliance costs, corrective action plans (CAPs), and fraud, waste, and abuse (FWA) scrutiny—even when the audited entity itself has not engaged in misconduct. By using high-quality NEMT providers, such as, for example, Non-Emergency Medical Transportation Accreditation Commission (NEMTAC) Accredited Providers and NEMT Providers who can demonstrate they meet the requirements set forth in the NEMTAC Accreditation Standard paying sources (health plans, MCOs, SNFs, brokers, etc.) can reduce audit-related cost, CAP exposure, and FWA risk, and in doing so these organizations can  provide NEMT services at a lower total cost by paying higher rates to high quality NEMT providers. How, you ask?  Quite simple actually, high quality NNEMT providers will reduce downstream compliance, audit, and enforcement expenses that are rarely captured in per-trip pricing models. Audits impose real and recurring costs. Internal compliance teams must devote extensive time to gathering provider documentation, validating credentials, reconciling records, and responding to follow-up requests. Even when documentation ultimately exists, the effort required to produce and verify it is substantial. When deficiencies are identified at the provider level, brokers, health plans, and paying sources are often required to implement corrective action plans that consume resources over extended periods. Critically, these costs are rarely attributed to the “price” of NEMT services, even though they are a direct consequence of how those services are sourced and managed. Some brokers and health plans rely on NEMT providers supplying attestations of compliance for credentialing drivers and vehicles instead of submitting full documentation upfront. While these models may reduce onboarding friction or appear cost-effective on a per-trip basis, they materially increase risk during audits.  When auditors request documentation, the burden shifts to the audited entity to demonstrate that compliance existed at the relevant time. If providers cannot promptly produce complete, accurate records—or if documentation is inconsistent or missing—the result is often a finding against the broker, health plan, or agency. These findings frequently lead to CAPs, enhanced oversight, and, in some cases, escalation to OIG or Attorney General review. Even when providers are eventually able to produce documentation, voluntary compliance models tend to generate higher administrative costs. Internal teams must spend more time tracking down records, validating their completeness, and explaining inconsistencies to auditors. These labor costs, while real, are rarely visible when evaluating provider pricing alone.  NEMTAC Accredited NEMT Providers, for example, avoid many of these costs since they have all of their credentials stored in a credentialing exchange that can be instantaneously accessed and verified by authorized parties, such as auditors and regulators. NEMTAC accreditation offers a different approach—one that reframes how the cost of NEMT services should be evaluated. Accredited providers undergo independent, standardized validation of compliance across the domains most frequently examined during audits, including driver qualifications, vehicle safety, insurance coverage, operational policies, documentation practices, and internal controls. Because accredited providers have established policies and procedures in place, they present a lower risk of documentation gaps, data inconsistencies, and systemic compliance failures. This reduces the likelihood that provider-level issues will translate into costly audits, CAPs, or enforcement actions for brokers, health plans, and paying sources. Can brokers, health plans, and paying sources get the same results with quality NEMT providers that have not obtained NEMTAC Accreditation?  The answer quite simple is yes, however , these groups would need to have their own internal resources to ensure that the NEMT providers in their network meet the same high standards and requirements for compliance as accredited providers.  Essentially, they would have to reinvent the wheel to get to the same level of comfort that an independent body, such as NEMTAC, provides. Having a network consists of NEMTAC Accredited Providers and/or “accredited equivalent” NEMT providers has important implications from a total cost perspective. While these NEMT providers may command slightly higher reimbursement rates than other organizations providing NEMT services, those incremental costs will most assuredly pale when compared to the significantly higher costs associated with: Internal compliance labor devoted to audits and provider remediation Costs associated with developing, implementing, and monitoring CAPs Network disruption caused by provider suspensions or emergency replacements Exposure to FWA investigations driven by poor data quality or weak controls When these downstream costs are considered, organizations may in fact be providing NEMT services at a lower overall cost  by contracting with only high-quality compliance-tested NEMT providers, even if per-trip prices are modestly higher. These high-quality NEMT providers also present a lower risk of committing fraud, waste, and abuse. Providers with formal policies, documented procedures, and ongoing compliance oversight are better positioned to prevent both intentional fraud and accidental non-compliance. Clear documentation standards reduce the likelihood of bad data entering claims or encounter systems, while governance and training controls support accurate and consistent reporting. In the current enforcement environment, this distinction is critical. OIG and Attorney General reviews often begin with data anomalies or documentation gaps, even when no fraud ultimately exists. Investigating and resolving these matters can be expensive, disruptive, and reputationally damaging. By reducing the likelihood of such triggers, accredited providers help control costs that are otherwise externalized onto brokers, health plans, and paying sources. With the current high-audit risk environment we are experiencing with Federal, state, and watchdog organizations placing an increased focus on fraud, waste, and abuse, the likelihood of a broker, health plan, MCO, or state Medicaid agency being subjected to multiple audits per year in not de minimis, and each audit will require significant internal effort. Even conservative estimates would surely indicate that reductions in compliance labor, corrective action costs, and network disruption achieved by using only NEMTAC Accredited or “accredited equivalent” providers will generate annual savings on the order of tens of thousands of dollars per network. When viewed alongside the modest incremental cost of contracting with the higher quality and higher compliant NEMT providers, these savings suggest that total program costs will actually decline, even if nominal provider rates increase . Importantly, this analysis does not fully capture avoided enforcement risk, reduced likelihood of extended investigations, or long-term benefits associated with improved regulator confidence.  (See Figure 1 below) All of this discussion has not even focused on the significant cost savings to the health care ecosystem these same providers deliver through increased reliability.  The processes these providers have in place translate into fewer missed critical medical appointments.  Studies have shown that overall health care costs escalate dramatically when individuals are taken to emergency rooms in an ambulance and from additional procedures required as a result of missed medical appointments.  As oversight of non-emergency medical transportation continues to intensify, organizations responsible for NEMT programs must look beyond per-trip pricing and consider the full cost of service delivery. Provider-level compliance failures drive audits, corrective action plans, and fraud investigations that impose substantial and often hidden costs on brokers, health plans, and paying sources. The use of NEMTAC-accredited providers and/or providers operating to the accreditation standards offers a practical and defensible way to reduce these costs. By lowering audit burden, limiting corrective action exposure, and mitigating fraud, waste, and abuse risk, accredited providers can enable organizations to deliver NEMT services more efficiently and at a lower total cost, even when reimbursement rates are modestly higher. In an environment of heightened scrutiny from OIG, Attorneys General, and other regulators, incorporating independent accreditation into an NEMT network strategy represents not only a compliance improvement, but a sound economic decision.   Dan serves as Past-President of The Transportation Alliance and sits on TTA’s Executive Committee, as well as the TTA Foundation Board of Directors.  He also serves on NEMTAC’s Board of Directors and is Co-Chair of NEMTAC’s Safety & Training Advisory Committee.  He is past Chair of NEMTAC’s Accreditation Advisory Committee, Compliance & Regulatory Advisory Committee, and the Technology Advisory Committee.  Dan is a frequent author and speaker on issues related to the passenger ground transportation industry.

Last week, Grove Transit ’s President, Dan Reid, joined transportation leaders from across the country at The Transportation Alliance (TTA) Open House, hosted at Driverge Vehicle Innovations in Akron, Ohio. The two-day event brought together operators, vendors, and industry experts for hands-on learning, thoughtful discussion, and—of course—some much-needed networking. A Behind-the-Scenes Look at Accessible Vehicle Innovation One of the highlights of the event was an exclusive tour of Driverge ’s vehicle conversion plant, led by President Mark Minatel. The group got a rare behind-the-scenes look at the development process of a new ADA-compliant conversion built on the Toyota Sienna platform. From manufacturing details to design challenges, it was a true “peek behind the curtain” into how accessible vehicles are built from the ground up—something few operators get to experience firsthand. Operators in the Driver’s Seat: Collaborative Conversations After the tour, Jim Cermak hosted a roundtable with members of the Driverge management team. This wasn’t just a sit-and-listen session—operators like Dan had the opportunity to share real-world feedback on vehicle features that could make a difference in everyday service. Lesli Paoletti, Driverge’s Product Marketing Manager, took detailed notes as operators explained what works, what doesn’t, and what’s needed in future vehicle builds. Jim also shared driver training best practices, offering practical strategies that providers can bring home to improve service and safety across the board. Focus on Safety, Insurance & Securement Systems During lunch, James Hawks of AMF Bruns took the floor to present on securement system innovations—an often-overlooked, but critical component of ADA transportation. His insights into rider safety, product updates, and user-friendly features sparked great conversations among attendees. Later that day, Dan Reid co-led an insurance and safety roundtable alongside Jessie Coffey of National Interstate Insurance. The session touched on everything from insurance trends to loss control best practices, giving providers actionable tips to strengthen their operations. Big Ideas and Bigger Connections The Open House wasn’t just about products and policy—it was also about people. Attendees included representatives from: • TriStar Transportation • Fox River Taxi (WI) • Ace Taxi • Black & White Transportation • Americab • RideNSafe (Dallas) • RMS (Georgia) • Hope Town Special shoutout to Jeremy Oliver, Ted St. John, Cliff Montemayor, Stone Pinson, Hayes Stills, Devo Bavishi, and Adam Ciganik for sharing stories, asking great questions, and helping move the industry forward. We’re especially looking forward to hearing more about Hope Town at Mobilize in Las Vegas later this year. Wrapping Up with Training & Top Golf After a full day of learning, attendees met up at Top Golf for a little fun and face time with new colleagues. On Wednesday morning, Jim Cermak returned to lead a CTAA Train the Trainer certification session—giving providers a chance to strengthen their own leadership skills in driver education. A Word From Dan Reid Reflecting on the event, Dan shared "As usual, I left the event with a pad full of notes and best practices we're already putting into action at Grove Transit and GoRide . I also left with new colleagues I know I can reach out to if I need advice. These Open Houses always deliver real value. I've never attended one without walking away better informed and better prepared. It's proof that The Transportation Alliance is truly committed to driving value for its members." Special thanks to: • Driverge Vehicle Innovations for their incredible hospitality and insight • AMF Bruns for providing lunch • National Interstate Insurance for sponsoring the insurance discussion • And all the providers who traveled from across the U.S. to make this event so impactful The collaboration, knowledge-sharing, and community spirit shown during this Open House are exactly what move the NEMT industry forward—and we’re proud to be part of it.

"Without NEMT Millions would face challenges in reliably accessing medical care." The threat to Medicaid and NEMT is real and has potentially devastating effects on our healthcare system. Each year more than 100 million NEMT trips are provided through Medicaid, many of these trips taking people to and from life-sustaining medical treatments such as dialysis and chemotherapy. Even the seemingly less crucial trips for routine check-ups or to treat minor illnesses are important because, without NEMT services, many children lack adequate pediatric care, and patients overcrowd emergency rooms for routine medical appointments. Medicaid is vital for millions of Americans, ensuring that low-income individuals, children, seniors, and those with disabilities have access to essential healthcare services. Because NEMT is just a small part of Medicaid services, it can be overlooked. However, NEMT saves lives and improves health outcomes, and can reduce overall healthcare costs. Without it, millions would face immense challenges in reliably accessing medical care, leading to costly consequences for patients and taxpayers alike. The Medical Transportation Access Coalition (MTAC) estimated that NEMT prevents Medicaid from spending an additional $40 billion each year from avoided emergency room visits and hospitalizations. In Florida alone, a Florida State University study determined that this equates to a saving of $11 for every $1 spent on NEMT trips. Another MTAC study found that NEMT saves Medicaid $40 million a month, or $480 a year, for every 30,000 individuals who rely on NEMT for transportation to dialysis, diabetic wound care, and substance abuse disorders. Many individuals accessing NEMT transportation do so because they have no other resources or options for getting to or from medical appointments. Taking away, or significantly curtailing Medicaid NEMT will result in these same individuals missing appointments and then resorting to ambulance rides and emergency room visits. This places a tremendous financial burden on taxpayers and diverts scarce EMT and ER resources to be used on what could have been avoided trips and visits. The Kaiser Family Foundation estimates that Medicaid spent $3 billion on NEMT trips last year, and when you divide that by the 103 million estimated Medicaid NEMT trips performed each year, it works out to about $30 a trip. These numbers represent significant savings when compared to the estimated cost for an ambulance ride of between $1,200 and $2,500, and/or the cost of an average emergency room visit of $2,000 to $3,000. Further, the problems encountered if NEMT is eliminated, or even curtailed, extends beyond just stretching already scarce resources, but also result in longer wait times due to overcrowded emergency rooms, overworked healthcare providers, and increased medical costs for both insured and uninsured patients. When individuals can engage in even basic preventive care, they can avoid exacerbating chronic conditions. When access to that care is missing, it can result in drastically increased Medicaid expenses over their lifetime. It should go without saying, but it does need to be said, protecting Medicaid and NEMT is not only the right thing to do, it’s a great investment. If you don’t support maintaining Medicaid because it provides much needed services for those in truly in need, then support it because it makes good financial sense. After all, isn’t that what all this talk about cuts and slashing is all about? I can’t think of a single investment where you wouldn’t spend a $1 today if it meant you would save $11 in the next year, so why is Medicaid and NEMT any different? A good investment is a good investment, and investing in Medicaid and NEMT today prevents billions in avoidable healthcare costs tomorrow. If you can’t support Medicaid and NEMT with your heart, do it with your wallet, but the most important thing is to make your voice heard. Let your elected officials know that you want them to make the sound fiscal choice. Make sure they understand that cutting Medicaid funding or reducing and restructuring the program through block grants to the states could threaten this essential service, leading to worse health outcomes for vulnerable populations and increased financial strain on our healthcare system and the economy. People encounter transportation issues every day and we solve those problems.