Oak Bluffs has acknowledged overcharging the federal government for Medicare and Medicaid reimbursements through its off-Island ambulance run billing company, Comstar. The town has credited back a combined $37,535.07 after discovering overcharges for off-Island ambulance runs.
Oak Bluffs worked with Comstar to address issues with its federal billing program and reimbursements operated through Medicare and Medicaid, according to town administrator Robert Whitenour, who informed the board of selectmen on Sept. 24 of the outstanding amounts for which the town filed for ambulance runs that did not end at a Medicare- or Medicaid-certified facility.
Whritenour said these amounts were before Comstar and the town became aware of the issue and discontinued seeking these reimbursements in 2017.
Medicare is a federal program that provides healthcare coverage for people over the age of 65, or under the age of 65 if they have a disability — regardless of income. Medicaid is a state and federal program that provides healthcare coverage for those who have a low income.
Whritenour said under current rules, the town is responsible for paying back some of its reimbursement claims from the past six years. According to the records of the overpayments, the total amounts are $26,084.77 for Medicare and $11,450.30 for Medicaid, totaling $37,535.07. Oak Bluffs had overcharged on 61 trips for Medicare and 56 for Medicaid.
The town is off the hook for the other $158,169.52 that accrued from 340 trips that stretch back to 2003 for Medicare, and the $23,064.97 from 111 trips going back to 2003 for Medicaid, due to Medicare and Medicaid rules, according to Whritenour.
Whritenour told The Times he was “aware of the issue generally,” but upon further inquiry found out the debts were still outstanding.
After discovering the overpayments existed, the town immediately began crediting back the combined $37,535.07 to Medicare and Medicaid.
“As far as I know the credits have been processed back to 2013, and I have no update as to guidance from Medicare/Medicaid on amounts previous to that,” Whritneour wrote in an email to The Times.
Whritenour also told The Times Medicare and Medicaid did not request interest on top of the debts.
“There’s a constant stream of reimbursements coming in,” Whritenour said. “It will be done as a means of credit to them.”
At the September selectmen’s meeting, Rose told selectmen that off-Island ambulance companies rarely come to the Island to pick up Medicare or Medicaid patients because it’s too expensive and not profitable. Oak Bluffs ambulances will transport a patient from the hospital to Woods Hole, but if it’s after 5 pm, Oak Bluffs EMTs have to transport the patient to another ambulance company because there isn’t time to travel to a hospital such as Mass General, drop them off, then make it back for the ferry the same day.
“There’s this whole slew of problems that come along with our crews getting stuck off-Island,” Rose said.
Comstar CEO Richard Martin declined to comment on the issue.
“When we became aware of potential Medicare-billed runs that may not be eligible under [Medicare/Medicaid] guidelines, we directed Comstar to contact them immediately and make whatever adjustments were necessary to achieve 100 percent compliance with all of their regulations, and my understanding is that’s been accomplished,” Whritenour said.
Whritenour added that the town does not deal with Medicare and Medicaid directly, but hires Comstar to do so.
“We rely, at least I do, on that company to know what gets billed to Medicare, what gets billed to the patient,” Whritenour said.
The Comstar contract was signed between Martin and Oak Bluffs Fire Chief John Rose. The contract has been automatically renewed each year since 2012.
The contract was not reviewed or signed by selectmen in 2009, and town officials say the contract should go back out to bid. Whritenour wasn’t overly critical of the multiyear lack of oversight.
“I don’t know if that’s problematic, but it’s one of the issues that we’ve addressed with the chief,” Whritenour said, adding that going forward, selectmen would be involved in any contract discussion. “I would like to see a new procurement done on that contract. It was done at some point historically, but I think it needs to be refreshed.”
Selectmen chair Brian Packish, who was not on the board in 2009 when the contract was signed by Rose, told The Times the contract is something that needs to be updated.
“It’s an old contract that definitely needs to go back out to bid,” Packish said.
Whritenour said he’s directed Rose to put together “specifications” to rebid the contract.
“It needs to be brought up to modern times and standards.”
Income from ambulance runs goes into a fund which can be used to purchase public safety equipment, according to Whritenour.
“It’s been problematic in recent years. One of the big issues that we faced is with more and more of the runs coming under Medicare and Medicaid, it has produced the problem that their regulations, evolving as they are, are continually squishing the amount that’s allotted to ambulance runs,” Whritenour said. “There is a shifting paradigm that that agency has adopted that really makes it so that if it’s a Medicare run, it costs more than Medicare pays.”
According to Whritenour, the total revenue generated from the ambulance runs has been declining.
It’s not the “enormous cash cow that some people may have a perception of,” he said.