JEMS repaying

Jay Emergency Medical Service is paying a more than $83,000 settlement to Medicare and Medicaid after errors were found in billings from April 2011 through March 2017.

The settlement is less than a quarter of what was billed to both government-funded health plans.

County attorney Bill Hinkle, during a joint meeting of Jay County Commissioners and Jay County Council on Wednesday, cited the reason as unintended filing errors. Commissioners signed documentation to more forward with the settlement, and council made the additional appropriation in the amount of $83,223.

JEMS signed a five-year contract with AccuMed Billing Inc. starting in April 2017 to provide billing services for ambulance runs, Hinkle read from a prepared statement.

As part of its standard procedure, AccuMed reviewed billings submitted by JEMS to Medicare, Medicaid and private health insurance agencies. The company found billing deficiencies submitted to the government-funded health plans.

Hinkle contacted both council president Jeanne Houchins and then-commissioner president Chuck Huffman about the situation. They contacted law firm Hall-Render of Indianapolis for assistance with the case, and attorney Steve Pratt suggested an audit.

Nearly 4,400 claims were submitted to both Medicare and Medicaid in the six-year period, as determined from an audit by certified public accountant firm BKD.

BKD randomly chose 100 claims for a closer evaluation and found some were lacking proper certification for non-emergency transport, some with coding errors and one without a medical necessity.

“The physician who orders the transfer has to document why the patient has to go by ambulance as opposed to any other means,” explained JEMS director Gary Barnett. “They have to document the reason why an ambulance is absolutely required and the crew has to mimic that verbiage into the documentation of the chart.”

Claims submitted to Medicare and Medicaid must be for a medical necessity, have proper certification and coding numbers, and be signed by either the patient or family. Failure to properly document and file is a violation of both government plans and can result in additional fines.

BKD initially used a software program to determine about $170,000 overcharged to Medicare and about $220,000 overcharged to Medicaid. Up to a 200% penalty fee could have been added to the county’s repayment of these amounts as well.

Jay County self-reported the errors to the U.S. attorney for Medicare violations and the Indiana attorney general for Medicaid violations.

Pratt argued to both parties that most of the errors resulted from failure to properly file documentation for medically necessary ambulance runs, Hinkle said. He suggested JEMS repay both Medicare and Medicaid for the claims which were not medically necessary.

The U.S. attorney found services improperly billed to and paid by Medicare totaling $32,288. The Indiana attorney general determined the amount owed to Medicaid at $23,094. 

With a 150% penalty fee tacked onto each amount, the total settlement is $83,223.

“So, basically it was just a paperwork issue –– nothing that was intentional, fraudulent, or, we’ll say, grossly negligent,” Hinkle said.