As a convicted killer out on supervised release, Ronald A. Vashone-Caruso couldn’t drive a taxi or hold certain jobs in Colorado. But in 2013 and 2014, Vashone-Caruso ferried Medicaid patients to and from their medical appointments in his car under a state program that doesn’t closely monitor its drivers.
One Medicaid patient filed a complaint alleging Vashone-Caruso texted her repeatedly after driving her to the doctor, frightening her.
The Colorado Public Utilities Commission licenses companies to provide drivers for the state’s non-emergency medical transport program. The commission, however, does not require background checks of those drivers as it does with cabbies.
The state agency that administers the program does require its primary contractor to conduct criminal records checks, but a Denver Post investigation found loopholes. Drivers don’t have to submit fingerprints to be run through Colorado Bureau of Investigation and FBI crime databases, a requirement for 64 other professions in the state.
In addition, The Denver Post found, the system has fractured oversight. In a nine-county region that includes the Denver area, the state contracts with a broker that hires companies to provide the service. In the rest of the state, counties contract out the service under their own rules and regulations.
The Non-Emergency Medical Transportation program provides hundreds of thousands of rides for indigent Medicaid patients annually, including foster children and nursing home residents.
“You’ve got to figure out how to strike the right balance to make sure the people who rely on you are safe,” said Matt Salo, executive director of the Washington-based National Association of Medicaid Directors. “It’s a real program integrity issue, but you don’t want to go too far where you are creating a draconian system that treats all potential drivers as if they’re a felon and discourages anyone from doing the work.”
The extent of problems with drivers in Colorado is unknown. The Post asked for their identities, but a spokesman said the utilities commission does not know who they are because it licenses only the companies.
Colorado’s Health Care Policy and Financing Department, which pays the Medicaid bill for transports with federal and state funds, also couldn’t provide a list of drivers.
The department is considering changes to the background check system after The Post raised issues about the program.
“That may include requiring additional questions on the driver application, and/or requiring further steps in the criminal background check,” said Marc Williams, spokesman for the state agency, in a prepared statement.
A porous system
Programs that are lenient in regulating such drivers can be ripe for abuse, according to a 2009 report from the inspector general for the U.S. Department of Health and Human Services.
“The Office of Inspector General and other entities have identified significant vulnerabilities to fraud and abuse in State NEMT programs,” that report found.
The report found that 62 percent of the states require criminal background checks for such Medicaid drivers and urged states to screen those drivers closely.
Federal officials have rapped other states for loose controls on the program. Last year, the inspector general for the federal Department of Health and Human Services found that Texas had improperly spent $30 million in federal Medicaid reimbursements on transports that did not comply with regulations. That review found Texas providers in the program couldn’t regularly document criminal background checks were being conducted.
In Colorado, the current system is so porous that it allowed Vashone-Caruso to provide medical transports to the most vulnerable of society.
Vashone-Caruso was convicted in the early 1970s of shooting a liquor-store clerk during a robbery. He escaped prison in 1974 while on leave for his stepfather’s funeral by locking an officer in the trunk of a car.
After his capture, he tried to escape the Denver County Jail and stabbed two deputies, killing Deputy John D. Osborne.
He was released from prison, where he was serving a life sentence, to a community corrections center in 2010. He then progressed in 2011 into the community on his own under an intensive-supervision inmate program, with global position system monitoring.
He began working as a non-emergency medical transport driver in 2013.
Records show that a woman complained late last year about Vashone-Caruso, and felt vulnerable given his criminal record and his repeated attempts to contact her after providing a Medicaid transport. She contacted an investigator with the Colorado Department of Corrections, who advised her to consider getting a restraining order if Vashone-Caruso continued harassing her, records show.
The utilities commission investigated and took action against him because of lapsed insurance — but not because of his criminal background.
Vashone-Caruso told investigators that Liberty Transportation, the company that hired him, had gone out of business. He also denied that his insurance had been canceled. He said his liability coverage had changed, and the commission hadn’t been notified of that change.
Denver traffic records show he caused two accidents during his time as a Medicaid driver, rear-ending vehicles on two separate occasions.
Even after his company’s license was revoked in September of 2014, Vashone-Caruso continued providing Medicaid transports. He provided 110 Medicaid transports in November and December 2014, the records show.
In an interview, Vashone-Caruso, 66, denied mistreating any of his customers.
“I made sure people got where they needed to go and where they needed to be,” he said.
He said his time in prison was a benefit, not a hindrance in customer care. He said he lost his freedoms during his incarceration, helping him identify with the disabled. “Just because someone has a checkered past doesn’t mean those past traits continue in the future,” Vashone-Caruso said.
Keeping records
Because no fingerprints are submitted for the state’s non-emergency medical transport drivers, background checks are less complete than those done for taxi drivers.
Name-only searches can be hampered by name changes and by spotty records prior to 1982, the year Colorado law-enforcement agencies were required to start submitting arrest information to the state bureau of investigation. Also, the fingerprint system searches FBI data, which is national, more comprehensive and includes arrests prior to 1982.
Taxi drivers not only get a more rigorous fingerprint check, but they are subject to continued monitoring. If they are arrested, an alert is sent to the commission, which can then use the alert to revoke their license.
Colorado’s Department of Health Care Policy and Financing
has a contract with Glendale, Ariz.-based Total Transit to act as a broker for transports in the counties of Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer and Weld, where nearly 40,000 Medicaid transports occur each month. Vashone-Caruso was authorized to work in the counties of Adams, Arapahoe, Denver and Jefferson.
The state does audit broker records for contract compliance but hasn’t completed an inspection for Total Transit, which took over the service last year. Past inspections by the state of a previous broker found deficient record-keeping, including Medicaid drivers who weren’t accounted for in employment files, no criminal background check for one driver, a lack of driver’s insurance in some instances, late vehicle inspections and unreadable drug screenings for drivers.
The state agency’s contract with Total Transit specifies that the company is supposed to ensure the drivers don’t have violent felonies in their past. Total Transit officials refused to comment on the matter or to explain how they allowed Vashone-Caruso to do such work for them when he has violent felony convictions.
Williams, spokesman for the state health care policy department, said Vashone-Caruso might have slipped through because he was using a name different than the name he was convicted under.
Hafedh Ferjani, the husband of the owner of Liberty Transportation, said his wife never checked Vashone-Caruso’s criminal background before hiring him to do the medical transports.
Colorado Department of Corrections supervision records show Vashone-Caruso got a new job in January at Denver International Airport to taxi airplanes.
Christopher N. Osher: 303-954-1747, cosher@denverpost.com or
