DAVENPORT — The city of Clinton submitted false claims to Medicare, which was in direct connection to the city’s failure to train its billing staff, an ambulance billing and coding expert retained by Michael Walker testified in court Friday.
According to J.R. Henry, a Pittsburgh-based emergency medical services consultant, the city submitted a number of claims that did not comply with Medicare guidelines. This failure to comply with the guidelines of the federal program made those claims false, Henry testified.
Walker retained Henry through healthcare compliance and reimbursement consultant Lamar Blount in order to defend himself against a legal malpractice suit from the city of Clinton, which has been in court for two weeks.
The city is suing Walker because it claims he failed to properly analyze a federal False Claims Act suit that former firefighter Timothy Schultheis filed in 2008. Schultheis alleged the city was improperly billing ambulance runs at an advanced life support level instead of a basic life support level in order to get higher reimbursements from Medicare and Medicaid. That suit ended with the city settling with Schultheis and the U.S. Department of Justice for $4.5 million in 2010.
The city wants to recoup $4.67 million, the cost of the settlement along with attorney and expert fees.
In the 10th day of the legal malpractice suit, the city rested its case and the defense called Henry as its first witness.
Henry told the jury his background in emergency medical services and ambulance coding and billing, which includes several years as the chief of various ambulance services.
Before the underlying False Claims Act case was settled, Schultheis and his attorney hired Henry and asked him to complete a comprehensive claim review to see if the claims submitted to Medicare and Medicaid were compliant with those program’s guidelines, Henry testified.