TAMPA - Every year, Tampa Fire Rescue dispatches ambulance crews on thousands of calls, responding to everything from car crashes to heart attacks to accidents at homes.
And every year, more than half of those patients stiff the city on the bill.
Sensitive to the public perception of squeezing heart attack victims for money, the city hasn't tried particularly hard to recover its money, annually writing off millions of dollars in unpaid ambulance fees. Now, though, Mayor Bob Buckhorn wants the city to hire a private collection company to track down scofflaws.
Tampa Fire Rescue charges patients an average of $7 million every year for emergency transport, but more than 50 percent of those who get an ambulance ride skip out on the tab.
Many who fail to pay are patients without medical insurance, city officials say.
"Given the current economic climate, we understand that people are struggling and (we) want to be compassionate and sensitive, but we just can't let this go any longer," said Sonya Little, the city's finance director.
Details of the proposal are being worked out, but Little said the city plans to hire a collection agency to go after a portion of more than $9.5 million owed on delinquent accounts dating back three years. Debts incurred before that will be written off.
Tampa recovers most of the charges billed to patients through Medicare, Medicaid and private insurance, she said, but about three-quarters of the people transported by ambulance are uninsured.
The move comes as Buckhorn looks for ways to increase revenue to cover the city's operating expenses amid a continued decline in property tax revenue.
"These accounts have been on the city's books for ages," Little said. "Some of them are likely to be uncollectible, but we're going to try."
Ultimately, the proposal would have to be approved by the city council.
Councilman Mike Suarez said he supports the move but wants to make sure the city doesn't hire a company that "browbeats" patients who can't afford to pay the bills.
"There's a line you don't cross, like going after people who just can't pay," he said.
Hillsborough County, which is owed more than $10.6 million in unpaid ambulance fees, also has wrestled with the issue of using collection agencies to go after delinquents.
County figures indicate that nearly 30 percent of ambulance fees are charged to people who don't have insurance. The county collects about 14 percent of those charges.
"An increasing number of the patients who receive services are uninsured and thus, the percentage of self-pay has grown significantly," David Travis, Hillsborough County Fire Rescue's interim assistant chief for administration, wrote in a memo this year.
Still, unlike the city's cases, the majority of patients who get an ambulance ride from the county's fire rescue either have private insurance, Medicaid or Medicare, records indicate.
The county writes off uncollected debt from ambulance fees after three years.
A 2009 audit recommended the county commission hire a collection agency to pursue outstanding debt, but commissioners rejected the proposal.
"The department does not use tools such as a threat of discontinuation of service or property liens to incentivize collections," Travis wrote in the Feb. 24 memo to the county commission. "The department has not pursued collections of delinquent accounts."
Pasco County has used a collection agency to recover ambulance fees for more than 15 years. The company, MAF Collection Services, recovers about 10 percent of delinquent accounts it takes over from the county, collecting a 17 percent commission.
In fiscal year 2010, the agency collected $377,191 from $3.9 million in ambulance fees, said Joyce Pruss, who oversees ambulance billing for Pasco County Fire Rescue.
"That's about the average for most collection agencies," Pruss said.
Overall, Pasco recovers roughly 75 percent of its ambulance fees -- one of the state's highest rates -- through its own billing policies and efforts by the collection agency.
Unlike Hillsborough, Pasco keeps the debt on the books indefinitely and authorizes the company to report delinquent accounts to the three main credit ratings agencies.
"Pasco County never forgives a debt," Pruss said. "We don't write off anything."
Mark Anderson, a member the Tampa City Council's budget advisory committee, has been pushing the city for years to get more aggressive with collecting unpaid bills.
He said city officials have been afraid of public perception.
"They didn't want to be seen going after sick people who couldn't afford to pay," he said.
The city's reluctance to go after debt didn't stop officials from increasing ambulance fees three years ago to $600 for pickup and $10 each mile for a ride to a hospital.
The new fee structure, which doubled rates, was the first increase in eight years and generated more than $500,000 a year in added revenue for the city's general fund.
It also included a provision allowing the city to increase the ambulance fees by 3 percent annually if deemed necessary, but city officials haven't boosted the rates since then.
Rebecca O'Hara, director of legislative affairs for the Florida League of Cities, said Tampa isn't alone in the debate over whether to get tough on unpaid debts.
"Like any entity that provides services, cities incur outstanding debt," she said. "But given the economy, there's more of an urgency these days to recover that money."