The national NEMT market is projected to grow from $8.66 billion in 2021 to $15.58 billion by 2028, an increase of nearly 80 percent in less than a decade. The trend holds across Medicaid markets nationwide: spending is growing, but the infrastructure to verify what’s being paid for is not keeping pace.
The question isn’t whether that growth is happening. The question is whether health plans can verify what they’re paying for.
When NEMT programs were built, the goal was straightforward: get members to appointments. Audits have been an afterthought — and the infrastructure reflects that. As programs scaled, verification got pushed downstream. Claims are reviewed after the fact in retrospective audits months later with periodic reporting that arrives long after billing has been processed.
That approach made sense when programs were small and manual. It doesn't make sense now.
The gap between what gets billed and what can be verified is where fraud, waste, and abuse compound quietly. Without GPS confirmation built into the workflow, ghost rides (trips billed for members who were never picked up) advance to payment undetected. Duplicate claims pass through because reconciliation happens in batches, not in real time. Mileage inflation goes undetected because no system is comparing the billed route against the actual one.
Health plans are paying for trips they cannot confirm happened.
Most fraud, waste, and abuse (FWA) exposure in NEMT doesn't come from sophisticated schemes. It comes from structural gaps: systems that don't talk to each other, billing that isn't reconciled against trip data, GPS coverage that reaches only a fraction of trip volume, manual workflows that create opportunities for post-trip adjustment.
The pattern is consistent at the state level too. In North Carolina alone, NEMT expenditure reached nearly $207 million in 2023 —a 59% increase over four years. When those gaps exist at scale, the financial exposure is material and it compounds with every unverified trip that moves through the program.
We built the NEMT Integrity Risk Snapshot for health plan leaders who want a clear-eyed view of their program's structural exposure. The assessment evaluates data visibility across the trip lifecycle, operational controls and verification points, and billing validation controls and returns a risk tier and modeled exposure estimate specific to your program's profile. It takes three minutes. The result it surfaces might surprise you.
Get your NEMT Integrity Risk Snapshot →
Exposure estimates are modeled using industry benchmarks and publicly available improper payment data. This assessment is not an audit.