People who rely on medical transportation services are missing appointments or are being left stranded after getting medical care because of . Medicaid has paid the companies that run these services despite the shortage, which means that millions of dollars were wasted on rides that never came. And for those lucky patients who do get the rides Medicaid paid for, many have had to wait for hours at a time, NPR .

Medicaid pays these companies a fixed rate every year, and it’s a lot of money:

Two decades ago, Georgia was one of the first states to start using transportation brokers to manage its Medicaid transportation program. The two longtime providers in the state — Modivcare and Southeastrans — will receive a total of $127.6 million from the state this fiscal year. They are paid a per-member monthly rate that averages $5.60 in Georgia, regardless of how many rides, if any, a Medicaid user takes.

The brokers that the majority of the rides they’re responsible for really do, in fact, reliably shuttle patients to and from medical appointments:

Modivcare and other companies say only a tiny fraction of the rides they provide lead to complaints. “Our first priority is safe and reliable transportation,” Zerone said. In Georgia, 99.8% of its trips are complaint-free, she said.

Andrew Tomys, Georgia state director for Southeastrans, said 99.9% of the trips his company services in the state are “free of valid complaints.”

Both Modivcare and Southeastrans say they investigate each complaint to determine whether it’s valid. In Georgia, Modivcare reported to the Department of Community Health more than 3,200 late rides or no-shows over a year out of around 2.3 million rides. Southeastrans reported just over 900 such problems out of around 1.4 million rides.

Where there are “valid complaints,” Modivcare and Southeastrans it’s the fault of their subcontractors and the employees at these smaller companies. The message being these brokers will take credit for the rides that do come while blaming their contractors for those that don’t.

Either way, “valid complaints” accounting for a percentage point or two has still resulted in the companies being fined $4.4 million in the span of two years. Of course, the big brokers were essentially given a discount, according to , and ended up paying just $1.2 million for failing to pick up patients and other violations. Contrasted against the $127 million they charge yearly, a little over one million in fines is not bad.

To make matters worse, many cases of no-shows go unreported or are flat out ignored by the companies. Patients are fighting back, suing the brokers for the no-shows and cases where people have been hurt when shuttle drivers didn’t properly secure them or provide wheelchair-accessible transport. These are violations against the “Americans with Disabilities Act and other civil rights laws,” per .

The medical transports may not be reliable, but broker responses were. Southeastrans and Modivcare they don’t comment on pending litigation.