The Clinton Herald, Clinton, Iowa

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October 12, 2013

Walker Trial — Expert: City failed to train billing staff

(Continued)

He looked at 50 claims from 2005 and 50 more from 2008.

The city was not in compliance with Medicare guidelines in 22 percent of the clams from 2005 and 12 percent of the claims from 2008, Henry said.

As part of his work for Walker in the malpractice case, Henry reviewed 330 claims from 2003 through a portion of 2009. Of these claims, 18 percent were non-compliant, according to Henry.

He based this finding on the fact the city did not have an emergency dispatch protocol in place at the time, meaning it 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.

The city’s wrong-doing extended beyond non-compliance, Henry testified.

“My opinion is that for the claims I found deficient that the city of Clinton filed false claims with Medicare,” Henry said.

He made a direct connection between the city filing false claims and the fact that it did not train the finance department staff who submitted the claims.

“Without the training, they were not submitting compliant claims,” Henry said.

Accounting specialist Sarah Nolan testified Tuesday she was not trained on ambulance coding or billing and that her supervisor at the time, former finance director Deb Neels knew and told her she did not need to be.

Henry also opined the city failed to follow the Office of Inspector General’s compliance provisions by not having regular training and conducting periodic internal audits of the person who was the last one to “hit the button” to send the claims to Medicare or Medicaid for reimbursement.

“That, I believe, was a substantial cause of the claims being submitted that were not compliant,” Henry said.

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