MANCHESTER — American Medical Response, the national ambulance company that is now the subject of a city audit, has paid out close to $4 million in recent years to settle claims it overbilled patients in two other cities.
Independent City Auditor Kevin Buckley launched the audit last month at the direction of the Mayor and Board of Aldermen.
AMR is in the second year of a two-year contract with the city that is set to expire at the end of December. The aldermen will get to decide whether to renew the contract.
AMR concluded an internal audit that found that 323 ambulance trips out of nearly 5,000 in 2011 and 2012 had been “incorrectly billed.” In June, it forgave outstanding incorrect balances and issued $16,000 in refunds. But AMR patients have continued to complain about large bills from the company.
Buckley said he is in the data-gathering phase of his audit and is going over the database of charges provided by AMR.
In his preliminary research, Buckley discovered that AMR has been the target of legal action in Spokane, Wash., and in New York City.
Last year, AMR paid $2.7 million to settle federal charges that it defrauded Medicare and other federal health insurance programs. Prosecutors alleged that AMR “knowingly submitted falsely inflated claims” between 2001 and 2005 through its Brooklyn and Long Island offices.
In 2010, AMR agreed to pay $994,000 in a class action lawsuit brought on behalf of more than 12,000 residents of Spokane, Wash., who claimed to have been overbilled by the company.
The New York case was based on allegations that AMR engaged in “up-coding” — inaccurately classifying the nature of the service it provided, resulting in higher charges. Buckley said AMR’s internal audit didn’t look at this, but he said his review would.
Largest in country
AMR is the largest private ambulance service company in the country, providing services to more than 2,100 communities, according to its website.
In a statement, AMR General Manager Brendan McNiff, said: “We are working closely with the city in a transparent process to review our invoice procedures to assure that we are in compliance with the terms of the EMS contract. We apologize for any inconvenience caused by the situation.”
AMR took over as the emergency ambulance service in Manchester in January 2011, beating out the previous provider, Rockingham Regional Ambulance, for the contract with the fire department. Rockingham has since gone out of business.
At the time, aldermen based their decision largely on the bottom-line: AMR offered to pay the city $150,000 more a year than Rockingham to communicate through Manchester’s dispatch system.
There was no discussion of the legal action against AMR, nor was the Manchester Fire Department aware of it when the bids were being considered, according to Deputy Chief Nicholas Campasano, who is responsible for monitoring the contract.
Campasano said it was concerning to hear that AMR had been brought to court over its billing practices, but he said he would withhold judgment until the city audit is complete.
$1,630 per trip
Campasano also sought to dispel what he said was some of the “confusion” around what AMR is authorized to charge per trip under its contract with the city.
Department officials have said that the maximum amount AMR can charge is around $600 per trip, though many patients have reported being billed for more than double this amount. Under the city contract, the base amount AMR is authorized to charge is $578, not including charges for additional services and mileage. This figure, however, is the maximum one can be charged out-of-pocket, Campasano said. The typical insurance rate AMR charges is $1,630 per trip. If an insurer doesn’t cover the entire bill, a patient can’t be personally billed for more than $578.
“Some of that is just consumer confusion about how the billing process works,” he said. “On the other side, individuals who do not call 911, or transport from one facility to another, that’s not addressed in the contract,” Campasano said. “The only thing our contract deals with are 911 calls.”
AMR was ranked the 10th most expensive ambulance service provider in the state out of more than 300 companies, according to a report released in 2011 by the state Insurance Department, based on its average rate per trip of about $1,400.
The least expensive emergency trips cost $300 to $500, and most were provided by municipal-run services.
The report is based on data collected from April 1, 2009 to March 31, 2010.
Rockingham Regional Ambulance charged an average of $628 for emergency and non-emergency trips at the time, while AMR charged $1610 for emergency and non-emergency trips.
AMR also provides emergency ambulance services for Derry, Nashua, Hampstead and Somersworth.
Campasano said he could see why it is hard for people to understand how a short trip in an ambulance could cost so much. But, he said, “Twenty-eight percent of the time a call is dispatched, there’s no transport. Nearly 30 percent of calls are not reimbursed. That $1,600 bill is really subsidizing those other responses and those individuals with no insurance. It’s very similar to why a spoon in a hospital costs $3,000.”
Buckley, the city auditor, says he hopes to have a report on AMR to present to the aldermen for their September meeting.
He said residents who think they have been overbilled should contact him at 624-6523 or kbuckley@Manchesternh.gov.
AMR also provided contact information for those concerned about their invoices: Michael Marcozzi at AMR Patient Business Services at (330)762-8999, ext. 7495.