Duplicate reports with different wording for the same ambulance runs further concerned Wolfberg, which translated to credibility concerns for Walker. McGovern's request for paramedics to change codes from BLS to ALS and the fact that the city did not have copies of those e-mails but Schultheis had three also would have hindered the city's defense, Walker said.
Wolfberg said to "get these guys trained immediately," Walker testified.
McGovern, battalion chief Joel Atkinson and former fire chief Mark Regenwether subsequently attended a Medicare/Medicaid coding seminar. Upon returning, they maintained the city's procedures were correct.
Schultheis' repeated complaints to McGovern about the coding procedure and the fact that no changes were made went against the city's ability to say it did not knowingly submit false reports, Walker testified. The city's use of oxygen, IV and heart rate monitors on all patients regardless of care, the fact that McGovern spot checked 1 percent of reports and that he had made no changes to the coding procedures further fueled Walker's concerns.
Red flags for the city's defense went beyond McGovern. The fact that city had budgeted for several years to have all their ambulance calls billed as ALS showed Walker the city knew what was going on. When Walker learned Nolan was just inputting data for the bills to Medicare or Medicaid and not reviewing the reports sent to her from the fire department, it gave him further cause for concern because it showed the city was acting in deliberate ignorance, he testified.
Waterman asked Walker if he knew anything about the performance of former finance director Deb Neels, who was Nolan's supervisor.
"I heard she had issues," Walker said.
Further questions about Neels' performance were barred on the basis of hearsay.
Given all the things Walker found during his work on the case, he said the city couldn't claim it billed at a higher rate than it deserved through a mistake or misunderstanding.
"There were too many red flags. Too many people who knew what was going on. Too many people who were informed and chose to do nothing," Walker said.
Walker has been on the witness stand since Wednesday afternoon and will return for more testimony Monday as the case continues.