The Clinton Herald, Clinton, Iowa

Local News

October 15, 2013

Expert: Rule misused

DAVENPORT — The city of Clinton failed to understand and properly apply a rule that dictates ambulance coding, an expert hired by attorney Michael Walker testified Monday.

As the legal malpractice suit against Walker and his law firm Hopkins and Huebner entered its third week of trial, Pittsburgh-based billing and coding expert JR Henry returned to the stand where he faced a slew of questions 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.

According a report from Henry and healthcare consultant Lamar Blount, 18 percent of 330 claims they reviewed from the city from 2003 to 2009 didn’t comply with the rules set by Medicare. Henry tied this to the city’s misuse of the ALS assessment rule, particularly in regards to the use of a emergency medical dispatch protocol.

Because the city did not work with what Henry called a Medicare compliant dispatch protocol, the city could not use the ALS assessment rule. Under the rule, the city can code ALS if it has an emergency dispatch and an ALS intervention or an ALS assessment. The city did not use ALS interventions in the claims he noted as non-compliant.

“I do not believe they can use the ALS assessment rule and they must use the condition of the patient at the scene,” Henry said.

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