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EMSA Can't Know Who Overpaid, Board Told

TULSA, Okla. -- EMSA has no way to determine how many people have paid bills for ambulance service that they don't owe, CEO Steve Williamson told the agency's board Wednesday.

Dr. Ed Shadid, an Oklahoma City council member and EMSA trustee, asked Williamson whether he knew how many patients had paid bills even though they were paying a fee on their monthly utility bills to ensure that they would have no out-of-pocket ambulance expenses.

"There's no way for us to know," Williamson answered. "The only way we would know is to take a database of everybody we transported and run that against the database of everyone in the program."

A Tulsa World investigation has uncovered at least five cases in which EMSA sued people who were living at addresses where the TotalCare utility-bill fee was paid.

EMSA has dropped lawsuits against two of them and has refunded money to five other people. EMSA is a government agency that provides ambulance service to more than 1 million people in Tulsa, Oklahoma City and surrounding cities.

Residents can pay a monthly utility fee, $3.64 in Tulsa, to cover out-of-pocket costs for emergency ambulance service. EMSA sends all patients, even those paying the utility fee, a bill stating amount "due from patient" and "due upon receipt." The bills do not indicate that patients may be members of the utility program and therefore would not have to pay. EMSA also instituted a requirement that patients provide insurance information within 60 days or become responsible for the bill.

The requirement was not approved by EMSA's board and is not included in any city ordinances. A lawsuit seeking class-action status has been filed in Tulsa County alleging that EMSA fraudulently bills patients who are paying the utility fee. Shadid asked whether an investigative audit could be conducted to determine how many people paid the bill because they did not understand the program. He asked whether a random sample of records could be reviewed as part of such an audit. Williamson did not address the suggestion of an investigative audit but said even checking a random sample would be time-consuming. He said EMSA has attempted to check records on all ambulance runs made on a single day.

"It took a day to research one day's runs," he said. EMSA Trustee Gary Marrs, also an Oklahoma City council member, said he has received only three complaints from constituents. In all three cases, he said, the patients did not understand how the program worked and that they had to provide insurance information. During initial discussions about the utility-fee program, EMSA officials made it clear that they needed to bill patients' insurance even with the utility-fee funds. The programs were designed as a way to stabilize the amount of funds both cities were paying to EMSA.

"I want to stress to everybody that being in TotalCare doesn't keep you from having to take care of your business," Marrs said. He said patients who received bills incorrectly were responsible for following up with EMSA to correct the issue, just as they would with any medical provider. But Trustee Clay Bird, the city of Tulsa's economic development director, said: "The onus should be on us to determine that, and it shouldn't be up to the citizen to tell us whether they are in the program or not."

Dozens of people interviewed by the World said they called EMSA with questions about their bills and were never informed that they were in the TotalCare program. Bird said he was concerned that EMSA's administration instituted the insurance requirement without board or city involvement. He said the insurance requirement should be brought to the board for approval. Bird asked that board members be consulted before future meetings regarding what items they would like to have on the agenda.

"There seems to be a lack of engagement somewhat with the board," he said.

The EMSA board's chairman, Dr. James Griffin, said he believes that "it's a pretty big burden" for EMSA to determine how many people have accidentally paid bills they don't owe. Griffin said he believes that "only five or six" patients had been incorrectly billed.

"I don't think this is really as big of a deal as it's being made out to be," he said. In related business, the board approved a motion to spend up to $300,000 this fiscal year on advertising the TotalCare utility-fee program. At Bird's urging, board members agreed to seek proposals on the advertising contract. The agenda had sought a vote on whether to grant the contract - and spend another $300,000 next year - to Tulsa advertising agency Littlefield Inc. EMSA board members will meet next month in Stroud to review Williamson's performance.

Williamson has not received a personnel review during his tenure as the only CEO of the agency, which began in 1977. The trustees also will discuss travel spending for Williamson's role as president of the American Ambulance Association, a national industry group. Records show that EMSA has spent about $400,000 on travel, meals and related costs since fiscal year 2009 and that more than a third of that was for Williamson's role as president of the association. Contact EMSA EMSA CEO Steve Williamson said people who believe they were wrongly charged for services or paid ambulance bills they did not owe should call the agency.

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