An Oak Bluffs man has been contacted by the FBI about a large bill he received for an ambulance transfer to Woods Hole. In December, The Times revealed an FBI inquiry was underway at the Oak Bluffs Fire Department. The status of that probe, which encompasses the Oak Bluffs Ambulance Service, remains unclear. Oak Bluffs town administrator Robert Whritenour said the town has shown a high degree of cooperation with the FBI. He said he learned the FBI was “happy” with the information and documents the town has provided thus far. But he also said they haven’t revealed much else to town officials.
“The federal government has been kind of tight-lipped about what they’re looking at,” he said. “They haven’t given us any real updates.”
Oak Bluffs selectman Brian Packish was a bit more blunt about the FBI. “They tell us nothing,” he said.
The investigation ostensibly involves irregularities in medical billing for the ambulance service. In January, the town admitted to $37,535.07 in overbilling to Medicare and Medicaid. Whritenour said the sum was credited back to the federal government. It’s unclear what, if any, other overbilling is or was at play. Past and present members of the fire department and the ambulance service have been subpoenaed for one or more federal grand juries. An FBI spokesperson recently declined comment when The Times asked about the status of the investigation.
The man, who was an Oak Bluffs ambulance passenger, provided evidence to The Times of a trip from Martha’s Vineyard Hospital to the Steamship Authority terminal in Woods Hole that generated an invoice of $8,053.99. The passenger asked that only his first name, Donald, be used to protect his privacy.
It’s unclear if over-billing is at play, but Donald said he found the sum exorbitant, and Martin Greene, the interim Oak Bluffs fire chief, was taken aback when recently told the sum over the phone. Donald told The Times he had suffered a mild heart attack in February 2015. Because of a snow storm, he said, he could not be airlifted off the Vineyard to get to a higher-level care facility, as commonly occurs with cardiac patients at Martha’s Vineyard Hospital. Instead, Oak Bluffs Ambulance transported him across Vineyard Sound on a Steamship Authority ferry, and then transferred him to what he recalled as a Bourne ambulance. That ambulance then took him to Massachusetts General Hospital. In previous reporting, The Times found that the Steamship Authority charges $250 for an ambulance crossing, and the hospital covered that cost.
Donald said while he was billed $8,053.99 for the ambulance trip to Woods Hole, he only received an invoice for $550 for the ambulance journey to Boston. Earlier this year, Donald’s Oak Bluffs ambulance invoice drew FBI interest.
“I talked to an agent,” Donald said. “He wanted to see if I had any paperwork for the bill. And you know, it was funny, I was looking through all these boxes and I was about to throw out all this paper. Right on top was the bill, the original bill. I was like — ’almost threw it away.’ So I sent that to him and, you know, he said we’ll be in touch. And I haven’t heard a thing since.”
Donald said the FBI agent told him the ambulance ride from the hospital to the boat wasn’t covered and that insurance only covers direct transfers to another hospital like Massachusetts General.
It’s unclear if Oak Bluffs tried to bill Medicare for Donald’s trip. Oak Bluffs EMS Lt. Matt Bradley said he was unable to answer that question, but Comstar, the billing company for the ambulance service, would have the information. A representative from Comstar declined to provide the information, and said the company would not provide the information even with a HIPAA form from the patient (HIPAA, the Health Insurance Portability and Accountability Act, governs patient health information disclosure). Pressed on the subject, the representative, who did not provide her name, transferred the inquiry to a supervisor who identified herself as “Jennifer,” and said she was unable to answer the question. She later declined to provide her last name. Jennifer said a manager wasn’t immediately available to weigh in on the question, but expected one would reach out to The Times as soon as practicable. The next day Jennifer left a voicemail that indicated questions about Donald or Oak Bluffs Ambulance Service must be answered by the town of Oak Bluffs, specifically Whritenour — carefully spelling his name in the phone message. During a follow-up conversation, she reiterated that stance.
“Any questions like that have to go directly to him,” she said.
Getting the runaround
Donald recalled his frustration with former Oak Bluffs Fire and Ambulance Chief John Rose, who he said was unresponsive to his pleas for a bill reduction. Rose retired on April 30 in the wake of a sexual harassment settlement between himself and a firehouse employee, with divided selectmen opinion on his leadership capabilities, and the FBI digging into his department.
In a 2017 letter Donald wrote to Rose, Donald outlined his billing plight. “After I started to recuperate, the bills started to come in,” he wrote in part. “I had Health Safety Net at the time, which covered a lot of the bills. I owed Bourne ambulance $550, and I paid the bill. I owed a few thousand to Mass. General, and I have a monthly payment plan set up. But when I got a bill from the O.B. Ambulance for $8,000, I knew there was a mistake.”
Donald went on to write that he was advised by someone at Vineyard Healthcare Access to seek a hardship waiver from Comstar.
“Comstar told me what I had to fill out, and what to provide and to send back to them,” he wrote. “They said after they review the forms they would send to you for consideration. I can only guess my case got misplaced, as you said you never received it.”
Donald said Rose “would never answer me” on the telephone or in emails. Donald also said he was told on several occasions when he visited the station looking for him that Rose wasn’t there. Having no luck with Rose, Donald said he resorted to seeking help from Whritenour.
“I said, ‘Here’s what’s going on; $8,000 is too much, you know,’” he said he told Whritenour. “‘I’ll pay something, but I’m not paying $8,000 [expletive] dollars.’ I think he made some phone calls. He called me back. He said, ‘We’re going to lower it to $2,500.’ And I said, ‘OK, good. I’m going to pay a little bit each month and try to knock it down.’
An invoice dated Nov. 2, 2017 reflected the reduction. A $7,515.19 fee for “Specialty Care Transport” and a $538.20 fee for “Mileage” were trimmed by $5,553.99 to $2,500.
The invoice indicates the transfer was from Martha’s Vineyard Hospital to “American Medical Response.”
After the FBI contacted him, Donald opted to reach out to Comstar again.
“I called them up, and I talked to some guy, and he was really nice,” he said. “I said, ‘You know what, with all the articles I’ve seen about the ambulance service overbilling — I’ve been contacted by the FBI, I’m not going to pay anymore. I’m going to hang onto my money, and let’s see where this goes.’ And the guy says, ‘OK, I’ll put that in your file’. I said thank you, and I haven’t heard a thing from them since.”
Donald, a longtime musician who regularly does benefit concerts, said he harbors a lot of civic pride and “love” for Oak Bluffs, and felt conflicted about highlighting his billing travails. But the bottom line, he said, was he felt burned.
“Apparently they don’t love me,” he said of the town.
“I really don’t favor those ambulance rides to Woods Hole,” Whritenour said. He confirmed the town isn’t eligible to get medical reimbursement for such ambulance-to-ambulance handoffs because they don’t constitute conveyance to a licensed medical facility.
He said the town has been engaged in “joint problem-solving” on the issue, with Chief Greene’s assistance.
“There was some talk of reviewing the contract with the current billing company,” Greene said. But he said the pandemic sidelined the issue. He agreed that Woods Hole transfers were problematic for the town, compensation-wise. In general, Green said, off-Island ambulance transfers suffer from reimbursement deficits because the money paid by Uncle Sam is only a fraction of the true cost of a trip. One example, he said, was that some trips to Boston hospitals sideline ambulance crews overnight because they cannot get the ambulance back to Woods Hole in time for the last evening ferry.
“It’s a real challenge the town’s got to address at some point,” he said. “I can’t imagine we’re the only place in the country that has that problem.”
He said he’s reached out to Rep. Bill Keating’s office for guidance on the issue in May. Keating’s office confirmed they were working with him.
“Congressman Keating and his staff have been working with Chief Greene and Medicare to try to resolve this issue,” Keating’s communications director, Lauren Amendolara McDermott, emailed.
Asked if the FBI reached out to him, Greene said “surprisingly” they hadn’t, but they have, on occasion, made “records requests for emails or calls.”
Asked if $8,000 was reasonable for a transfer to Woods Hole, Greene said, “That sounds a whole lot wrong.” He went on to say, “From here to Boston, let alone Woods Hole, [it] seems a little steep.”
Greene said he wasn’t familiar with the particular invoice. “This is the first time I’ve heard of an issue like that,” he said.
Greene, who was formerly Bourne fire chief, said Bourne doesn’t do the type of transfers Donald described. He surmised it was an American Medical Response ambulance based on what the invoice indicates, and because he believes that company may have had a satellite office in Bourne.
“We want to lay the issue bare,” Whritenour said of billing problems with the ambulance company. Whitenour didn’t recall interacting with Donald. When asked about Comstar’s stance on Donald’s invoice, Whritenour emailed, “I am certain that the representative that [The Times] spoke to from Comstar erred in referring any ambulance billing questions to me, as I have no information in this area, nor have I ever heard of such a referral, so this is a surprise to me. I can only surmise that they do not provide individual patient billing information, as it may not be legal to do so, in which they would be correct in referring you back to the town, albeit not to me.”
Whritenour went on to write that he was willing to look into the invoice further with the town’s fire and EMS departments. In a follow-up phone conversation, Whritenour described Comstar’s stance on the invoice as “ridiculous.” A few days later he wrote, “I am informed that Medicare was not billed for that call.” He indicated this was according to Chief Greene. Greene confirmed this. David Apfel, an attorney who is representing the town specifically with the FBI and on billing matters, didn’t return calls seeking comment.
In a July telephone conversation with The Times, former Oak Bluffs Fire Chief Rose said Donald’s name “didn’t ring a bell.”