Attorney General investigates EMS for Medicaid fraud

  • Tue Nov 3rd, 2015 9:12pm

By Anna V. Smith

Journal reporter

San Juan Island Emergency Medical Services is being investigated by Washington State Attorney General’s office for potential Medicaid fraud.

A Civil Investigation Demand was issued to San Juan County Public Hospital District No. 1 on Sept. 25 by the attorney general’s Medicaid Fraud Control Unit.

The investigation was not brought up at a SJCPHD public meeting until Oct. 28, two days before the given deadline for the requested information of Oct. 30.

The 25-page document states the investigation “involves the possible submission of false Medicaid reimbursement claims for air ambulance services.”

It requests billing documents, reimbursement claims, forms, as well as all communication between “Larry Wall, Jim Cole, Dr. Michael Edwards or Dr. Michael Sullivan, or the superintendent on Board of the San Juan Island Public Hospital District No. 1 regarding Medicaid billing, Medicaid reimbursement or air ambulance service.”

It also specifically asks for the “entire personnel files for former EMS Chief Jim Cole, Director of Critical Care Transport Larry Wall, Dr. J. Michael Edwards and Agency Medical Director Dr. Michael Sullivan.” The SJCPHD Board is being represented by attorney James Fredman of Foster Pepper, PLLC of Seattle. In a prepared statement by Fredman read at the public meeting Oct. 28, the board acknowledged the investigation.

“The Attorney General’s Office is investigating Medicaid reimbursement claims for air ambulance services,” the statement read. “San Juan PHD No. 1 will fully comply with its legal duties in responding to this request for information.”

Foster Pepper is the same law firm that represented the district when responding to an American Civil Liberties Union letter in July requesting that the district change its policies and claiming it in violation of the Reproductive Privacy Act.

According to secretary to the board Pam Hutchins, the CID was initially mailed to an incorrect address, causing it to be returned and then emailed to the district on Oct. 2, after their scheduled monthly meeting on Sept. 23.

“The commissioners were made aware of the receipt of the CID. The commissioners can’t talk to all commissioners until a board meeting,” Hutchins said. “The next meeting after the receipt of the CID was October 28, 2015 which it was brought up. With a document such as this an attorney is needed to be hired and look at it to advise the next steps.”

Hutchins said that the hired attorney James Fredman worked out “a rolling submission” of the information instead of the hard deadline of Oct. 30.

“There is a lot of information requested and a rolling submission of it is more realistic,” Hutchins said.