As many as 30,000 people living inside the city limits of Spokane may have been overbilled by a private company that’s had a monopoly on ambulance services since 1998, according to documents presented at a hearing Friday before Superior Court Judge Jerome Leveque.
Spokane attorney D. Roger Reed, who is representing the ambulance patients in a class action lawsuit against American Medical Response, asked the judge to amend the suit to designate four types of plaintiffs.
The judge declined to approve that request but said he would order the ambulance company and the plaintiffs to each designate consultants to develop a method of reviewing transport records to identity all potentially overbilled patients.
Once the consultants develop the plan, the judge said, he would review it in light of federal medical privacy laws and the handling of documents in civil suits.
To develop a list of the estimated 30,000 plaintiffs, Reed and two other attorneys on his legal team have attempted to review Spokane Fire Department 911 calls and “medical incident reports.”
City officials initially were reluctant to turn over that information out of fear it could violate the federal Health Information Patient Privacy Act protecting certain data. It was released after a protective order was signed, restricting the release of only certain 911 patient information just to attorneys involved in the litigation.
AMR’s attorney, Paul Dayton, of Seattle, told the court on Friday that the ambulance company has an additional 160,000 pages of patient information that the plaintiffs’ attorneys are now attempting to review.
Reed said he needs to review the records to establish a list of names of patients, their addresses and the types of medical attention they received from AMR ambulance crews as part of the process of identifying those customers who may have been overbilled.
Dayton told the court he opposed any expansion of the suit or additional records reviews and said the ambulance company wants to get the case to trial, now scheduled for Aug. 6.
The judge said that trial date “may now be in jeopardy,” and he wanted to hold both sides to a schedule to get the 16-month-old legal fight settled.
The ambulance company already has completed its own patient-billing review and voluntarily paid $320,689 in refunds, and any further attempt to identify overbilled patients is a waste of time and money, Dayton told the court.
But Reed said that the company’s own records review was less than a full-blown audit, contained errors and omissions and only applied to Spokane residents who used AMR ambulances between 2004 and March 2006, and not the complete time frame of the two contracts.
Accounting procedures used in AMR’s private billing review were “substantially less” than standards established by the American Institute of Certified Public Accountants, Reed told the court.
City residents who may have been overbilled go back to 1998 when AMR got the first of two contracts awarded by the City Council, giving the company the exclusive right to provide ambulance service inside the city.
Under the contract, ambulance response times are regulated, subject to penalties, and AMR crews provide both Basic Life Support (BLS) and Advanced Life Support (ALS) medical care. The BLS rate is $358, and the ALS rate is $494.
If Spokane Fire Department paramedics ride in the ambulance with the patient, the company can only bill for cheaper basic medical treatment even if the more-costly advanced treatment is provided.
The lawsuit initially was filed in December 2005 by Lori E. Davis-Bacon and Lorraine and Doug Bacon, who contended they were billed for ALS services even though Fire Department paramedics were involved in giving treatment during the ride to the hospital.
The initial plaintiffs asked the court to expand their lawsuit to a class action, and Leveque approved that request last June.
The judge previously rejected two legal attempts by AMR to have the lawsuit dismissed, and he agreed to allow the plaintiffs to seek exemplary damages up to $10,000 for each violation and attorney fees.
Four months after the suit was filed, AMR announced in March 2005 it had conducted its own “audit” and publicly admitted in the course of a City Council Public Safety Committee investigation that it had overbilled some patients and would voluntarily be making refunds. Last summer, Mayor Dennis Hession fined AMR $80,172 for the overbilling – only a fraction of the potential fine the company could have faced.
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