The Clinton Herald, Clinton, Iowa

October 14, 2013

Trial update: Attorneys scrutinize expert

By Katie Dahlstrom
Assistant Editor

CLINTON — DAVENPORT — Attorneys in the city of Clinton's legal malpractice case spent this morning scrutinizing the opinions of the emergency medical services billing and coding expert hired by attorney Michael Walker.

As the legal malpractice suit against Walker and his law firm Hopkins and Huebner entered its third week of trial, Pittsburgh-based expert JR Henry returned to the stand to talk more about what he identified as claims for emergency services from the city of Clinton that didn't comply with Medicare.

Walker represented the city in a federal False Claims Act suit brought on by former firefighter Timothy Schultheis in 2008. Schultheis alleged the city knowingly submitted false claims to Medicare and Medicaid by using the advanced life support code rather than the basic life support code in order to receive higher reimbursements.  

The city claims Walker failed to properly analyze the case and his alleged negligence led to the city settling for $4.5 million in 2010. The city wants $4.67 million to cover the cost of the settlement as well as attorney and expert fees.

Court was adjourned early Friday so Henry could compare two exhibits, one which was a spreadsheet of the 330 claims he reviewed as part of his work in the legal malpractice case and the other a 425-page document that was supposed to contain the documentation from the 60 of those claims he identified as non-Medicare compliant.  

However, Henry testified that in his review of the documents over the weekend, he found three "issues" with the exhibits, one of which led him to reduce the number of non-medicare compliant claims to 59 because of a duplicate entry on the spreadsheet.

Documentation for one non-compliant claim was not contained in the 425-page document while some documentation for a claim he did not review as non-compliant was, Henry testified were the other two issues.

Following his rundown of the issues in the documents, Henry and Walker's attorney Bob Waterman reviewed one of the non-compliant claims that was from a patient who reported left-ankle pain. The crew did not perform an ALS intervention on the patient and Clinton County did not have an emergency medical dispatch protocol, but it was submitted as ALS. Further, the narrative on the patient care report stated the paramedics decided to "BLS" the patient, all of which led Henry to his conclusion that it was not compliant with Medicare.  

"If there's no ALS interventions performed, in my opinion, it should have been submitted at the BLS level," Henry testified.  

Waterman then turned his attention to the duplicate reports containing different information that have been discussed since the trial started. Based on his experience, as well as testimony from Walker, EMS Director Andy McGovern and Firehouse software representative David Stanton, Henry concluded the duplicate reports could not have been the result of a computer or software problem.

If it had been the result of a computer or software problem, there would have been entire tables of information that were different, not single fields on the report, Henry testified.  

Henry said he concurred with Stanton, finding the duplicate reports "very suspicious." The duplicate reports supported the notion that there was intentional conduct to falsify claims, he said. These duplicate reports did not result in duplicate billing, according to prior testimony.  

When Blake Hannafan, who is representing the city of Clinton, started to question Henry, he dug deeper into the "issues" contained in the exhibits, calling them "errors."

Hannafan called attention to one of the claims Henry had identified as non-compliant that contained information in two places stating an ALS intervention was performed. Henry admitted he was wrong in labeling that claim non-compliant, reducing the number of non-compliant claims to 58.   

Before the afternoon break, Hannafan started asking Henry to look over several manuals and documents that address the ALS assessment rule. He then compared the materials to Henry's belief that if there was no emergency medical dispatch protocol in place, the city needed to perform an ALS intervention on the patient in order to submit the claims as ALS.

In the examples Hannafan reviewed with Henry, the need for a dispatch protocol was not mentioned.

Henry's testimony will continue this afternoon.