The Wire — Week of November 2, 2026
A New Windsor couple is sentenced in the largest Medicaid fraud case Orange County, New York has prosecuted while an Ulster County NEMT owner pleads guilty, Louisiana puts its fee-for-service NEMT broker contract out to bid with proposals opening November 24, California’s auditor finds ride companies overbilled Medi-Cal nearly $31 million in mileage, CMS’s off-cycle revalidation wave reaches Texas, Montana and Illinois with unannounced site visits, Minnesota’s fuel adjustment lifts mileage rates, and rural researchers name the problem: unloaded miles.
The Wire is NEMT Wire's weekly news brief: the contract awards, rate moves, and regulatory decisions that decide who carries the trips. This week: a New Windsor couple is sentenced in the largest Medicaid fraud case Orange County, New York has ever prosecuted, Louisiana puts its fee-for-service broker contract out to bid, California's auditor finds ride companies overbilled Medi-Cal nearly $31 million in mileage, and the revalidation wave CMS ordered in April reaches Texas, Montana and Illinois.
1. New York: a 6-to-18-year sentence in a $3.4 million Hudson Valley NEMT case — and a second guilty plea in Ulster County the day before
State Comptroller Thomas DiNapoli and Orange County District Attorney David Hoovler announced October 27 that Rohail Raja, 45, of New Windsor, owner of Unique Class Limo Inc., was sentenced to six to 18 years in prison for first-degree grand larceny, and his wife Sharma Alam, 45, owner of SNR Limo Inc., to six months in jail and five years' probation for fourth-degree conspiracy. The two Medicaid transportation companies billed the state Department of Health $3,434,730 between April 15, 2020 and September 30, 2024 for rides that never happened or did not happen as billed — including trips on dates when provider records showed no visit, and shared rides billed as separate trips. The couple paid $400,000 in restitution at sentencing and were ordered to pay the remaining $3,034,730; both companies also pleaded guilty and were fined $5,000 each. Hoovler called it "the largest Medicaid fraud scheme ever prosecuted by the Orange County District Attorney's Office." One day earlier, DiNapoli and Ulster County DA Emmanuel Nneji announced that Mohammad A. Khan, 69, owner of Atlas Limo, pleaded guilty to second-degree grand larceny for stealing $227,000 between May 2024 and January 2025 by billing group rides as individual trips, billing rides that did not occur, and paying patients kickbacks to ride with him; he repaid the $227,000 and faces sentencing January 4. His son, Muhammad W. Khan of MAK Limo, was sentenced in September to three to nine years for stealing more than $1 million. With the Saratoga County arrest we covered last week still pending, the Comptroller's office says its Medicaid fraud investigations have produced 58 arrests and nearly $50 million in ordered recoveries in 18 months. What it means for you: in New York the forensic auditor is matching your trip claims against the doctor's own visit records. If an attestation can't be matched to a completed appointment, assume it eventually will be checked.
Sources: NY State Comptroller — New Windsor Man Sentenced to Six to 18 Years in Prison in Connection with Theft of Over $3.4 Million From New York By Submitting False Medicaid Provider Claims (Oct 27, 2026); NY State Comptroller — DiNapoli and Ulster Co. DA Nneji: Owner of Medical Transportation Company Pleads Guilty to Medicaid Fraud (Oct 26, 2026); Times Herald-Record via Yahoo News — New Windsor limo company owners sentenced in $3.4M Medicaid fraud scheme (Oct 28, 2026)
2. Louisiana: the state is re-bidding its fee-for-service NEMT broker — proposals open November 24
Louisiana's Office of State Procurement has posted solicitation Doc2358929885, "Transportation Broker for Medicaid Fee-for-Service Program for LDH," issued October 15 with proposals opening November 24, 2026 at 10 a.m. Central; no addenda had been posted as of this morning. The full RFP sits behind the state's Ariba portal (LESA event 1110028490), and the public notice gives no contract term, start date or scope detail beyond the title, so treat anything more specific as unconfirmed until the document is in hand. The incumbent is Verida: the Louisiana Medicaid Services Manual says "Verida (formerly Southeastrans) is currently authorizing and reimbursing" fee-for-service NEMT, which covers Medicaid members excluded from managed care plus non-emergency ambulance for adults in ICF/IIDs — managed-care members' rides stay with their health plans and are not part of this procurement. It is a smaller book than the MCO side, but it is the one state contract that any national broker can win outright, and a change would mean new credentialing and a new provider agreement for every operator in Verida's Louisiana network. Nothing changes for trips, claims or rates today. Watch LaPAC for addenda — including any move of the opening date — and keep your credentialing file current enough to hand to a new broker on short notice.
Sources: LaPAC — Doc2358929885, Transportation Broker for Medicaid Fee-for-Service Program for LDH (issued Oct 15, 2026; bid open Nov 24, 2026, 10:00 AM CT); Louisiana Office of State Procurement — Notice to Proposers, Doc2358929885 (PDF); Louisiana Medicaid Services Manual, Chapter 10: Medical Transportation (PDF; FFS broker footnote)
3. California: the State Auditor says ride companies overbilled Medi-Cal nearly $31 million in mileage in one year — and DHCS didn't catch it
In its October 15 state high-risk assessment of the Department of Health Care Services, the California State Auditor reported that more than 130 transportation providers billed Medi-Cal mileage at the rate meant for nonemergency ambulance trips during fiscal year 2024–25, collecting "nearly $31 million more than the allowable rate." The example the report walks through, "Transportation Provider J," was paid $3.55 a mile instead of the $1.30 allowed for nonmedical transportation, claimed more than $11 million in the year, logged near-daily 300-plus-mile trips for one beneficiary, and on a single day claimed trips for 35 beneficiaries, nine of them individually over 340 miles — yet DHCS did not open a referral on the provider until April 2026, after the auditor asked about it. A managed care plan, the report says, had "erroneously instructed providers" to bill the ambulance rate. DHCS referred two transportation providers to the Department of Justice in 2024 and none since as of July 2026, and the report flags the program's main utilization control — eight one-way segments a month unless the provider documents that the member asserted a need for more — as weak. The report is an assessment, not an audit, and makes no recommendations; DHCS disagrees with the high-risk label but says it is updating its transportation policy with more utilization controls. For California operators, that is the headline: tighter trip limits and mileage scrutiny are coming regardless of who was at fault for the rate, and if you have been billing at a plan's instruction, keep that instruction in writing. Our guide to Medi-Cal transportation enrollment is here.
4. Revalidation: the off-cycle wave CMS ordered in April hits Texas, Montana and Illinois — with unannounced site visits attached
The April 23 letters from CMS Administrator Mehmet Oz told every governor and Medicaid director to "swiftly" revalidate high-risk providers, to treat providers without an NPI as high-risk, and to file a two-year revalidation strategy within 30 days. The results are now landing in provider mailboxes. Texas: TMHP says HHSC is notifying affected providers on October 31 through PEMS, letter and email that they must revalidate earlier than scheduled; CMS requires the state to finish by June 5, 2028, there are no extensions, and a provider whose PEMS status is not "Closed-Enrolled" by its due date is disenrolled and must re-enroll from scratch. Montana: DPHHS's October 13 notice describes a two-year plan for moderate- and high-risk types, non-NPI providers and "high-vulnerability" services, with screening that can include unannounced site visits by the state's contractor and fingerprint background checks; missing the date means payment suspension and possible termination. Illinois: HFS moved high-risk and non-NPI providers to a two-year cycle on October 5, with notices by email only at 90 and 30 days and no retroactive reactivation for anyone who lets enrollment lapse. North Carolina stopped scheduling its site visits October 1 — moderate- and high-risk providers now get a window, not an appointment — and Colorado's November bulletin reminds providers that NEMT is a high-risk category requiring a site visit before enrollment. If you bill Medicaid directly in any of these states, check the email address on your enrollment record today; in Illinois and Texas that address is the only place the deadline will arrive.
Sources: CMS — Letter to Governors and State Medicaid Directors on Provider Revalidation (Apr 23, 2026; copy hosted by South Dakota DSS, PDF); TMHP — Certain Providers Must Revalidate Under CMS Revalidation Initiative (updated Oct 23, 2026); Montana DPHHS — CMS-Directed Off-Cycle Revalidation for Targeted Moderate- and High-Risk Providers (Oct 13, 2026, PDF); Illinois HFS — Updated Provider Revalidation Cycle (Oct 5, 2026); NC Medicaid — Unannounced Site Visits Effective October 1, 2026; Colorado HCPF — November 2026 Provider Bulletin, B2600544 (PDF; "Provider Enrollment Site Visits")
5. Minnesota: the quarterly fuel adjustment pushes wheelchair mileage to $1.92 and stretcher mileage to $2.71
Minnesota DHS's October 12 provider bulletin says it "updated fuel adjuster rates for Oct. 1, 2026," and the revised state-administered transportation rate page shows the result: lift- or ramp-equipped wheelchair trips (mode 5, S0209) now pay $1.92 a mile, up from $1.80 on July 1 and $1.76 on April 1, while protected (mode 6, S0215 UA) and stretcher (mode 7, T2049) trips pay $2.71 a loaded mile, up from $2.54 and $2.49. Base rates are unchanged — $19.80 for wheelchair, $75.00 for protected (attendant required), $60.00 for stretcher, plus $9.00 for an extra stretcher attendant (T2001) — and the page lists the mileage figures as quarterly fuel adjustments, so they can move again January 1. The rate page carries an October 6 revision date, which means October claims submitted in the first week of the month may have gone in at July rates; ask the MHCP Provider Resource Center whether replacement claims are wanted before you assume the difference is lost. If your Minnesota trips run through a county, MTM or a health plan rather than fee-for-service, ask them directly whether the adjustment passes through — the state page governs only what DHS pays.
Sources: Minnesota DHS — MHCP Provider Manual: State-Administered Transportation procedure codes, modifiers and rates (revised Oct 6, 2026); Minnesota DHS — New MHCP Information: Transportation Services (bulletin, Oct 12, 2026)
6. Rural: Minnesota researchers put a name on what breaks NEMT outside the metro — unloaded miles
A Daily Yonder feature published this morning follows University of Minnesota Duluth professor David Beard and Arrowhead Regional Development Commission planner Beverly Sidlo-Tolliver through a year of interviews across seven northeastern Minnesota counties on why medical rides fail in rural areas. Sidlo-Tolliver's starting point was a dialysis workshop two weeks after a transport company pulled out of the region: no state process required the departing provider to hand off its scheduled riders, "people were scrambling," and at least two patients missed dialysis and ended up hospitalized. Her diagnosis will be familiar to any operator — the deadhead to the pickup and the empty run home are "unloaded miles" Medicaid does not pay for, so "their reimbursement rate is not reflective at all to the total cost of that ride," and Minnesota's requirement for separate certifications from the Department of Health and the Department of Transportation keeps new drivers out. Beard's pitch is to the health systems: a missed appointment costs about eight minutes of staff time to reschedule, discharged patients waiting for rides hold beds, and transportation should be treated as part of care rather than "the patient's problem to solve." No policy change is attached, and a documentary is in the works. The useful part for operators is the vocabulary: when you are arguing a rate with a county or a broker, "unloaded miles" is the number they are not seeing.
Source: The Daily Yonder — Researchers Tackle Non-Emergency Medical Transportation (Nov 2, 2026)
7. Watch list: Colorado at 60 days, Michigan bids closed, CRUSH still at OMB, DC, Wisconsin, CMTA Friday
Colorado: HCPF's November bulletin restates the January 1 rule — no MediDrive scheduling and approval, no payment — and the facility portal instructions, and still cites Operational Memo OM26-060 while the NEMT hub page links OM 26-029; the hub confirms members outside the metro start booking through MediDrive December 1 and the member webinar is December 8 at noon. Michigan: the fee-for-service broker RFP (491-260000002254) closed October 30 with no amendments and no award posted, and the Auditor General's NEMT performance audit is still listed for "late 2026." Federal: the CRUSH proposed rule (RIN 0938-AV97) remains "Pending EO 12866 regulatory review" at OMB, received August 7, with its October Unified Agenda target now behind it. Washington, DC: no Contract Appeals Board decision in MTM's protest of the Verida award (P-1231) has surfaced; MTM Health is the broker through December 31 under the bridge extension. Wisconsin: DHS's vendor page is still dated August 25 and still says no time frame has been set for the move from MTM to Verida. California: CMTA's annual meeting is this Friday, November 6, at the Los Angeles Marriott Burbank Airport; no agenda has been posted.
Sources: Colorado HCPF — November 2026 Provider Bulletin, B2600544 (PDF); Colorado HCPF — NEMT statewide broker transition hub; RFP-491-260000002254-1 listing — NEMT Broker for Medicaid FFS Beneficiaries (response deadline Oct 30, 2026); Michigan Office of the Auditor General — Medicaid Non-Emergency Medical Transportation Services, work in progress; reginfo.gov — OMB EO 12866 review: CRUSH (CMS-6098), RIN 0938-AV97; Wisconsin DHS — 2026 Announcement for Wisconsin's NEMT Vendor; CMTA — Annual Meeting 2026
States in this piece:CaliforniaColoradoIllinoisLouisianaMichiganMinnesotaMontanaNew YorkNorth CarolinaTexasWashington, DCWisconsinNational / Federal