In September 2009, nearly a year after Schultheis filed his complaint on behalf of the U.S. government, it was unsealed following the feds’ decision not to intervene and pursue the lawsuit. The complaint stated that Schultheis had personal knowledge that the city had knowingly, deliberately or recklessly submitted all of its claims for ambulance runs to Medicare and Medicaid as advanced life support (ALS1) when some of the calls should have been classified as basic life support (BLS). As a result of this alleged fraud, the city received higher reimbursement rates from the government programs.
However, Schultheis testified Wednesday he had never seen a bill produced by the city to Medicare or Medicaid. While Schultheis said he complained numerous times to his battalion chief, Joel Atkinson, and EMS Director Andew McGovern, those complaints were about the way the city coded ambulance calls, not billed them as cited in his federal complaint. Schultheis also testified that while the complaint said the city received a higher reimbursement, he did not know what payments the city received from Medicare and Medicaid. Those payments went to the city’s general fund and were not earmarked for the fire department.
Schultheis said he complained to McGovern at least six times, maybe more about his disagreement with the city’s method for coding ambulance calls at the ALS level. His first complaint came in the summer of 2007 after he started completing patient care reports and coding on his own. When
he first complained, he said he was told it would be looked into. His later complaints didn’t warrant the same response. Schultheis said he was told the city of Clinton was an ALS service and all calls were to be coded as ALS. He was instructed by Atkinson to follow McGovern’s instructions about ALS coding.