Inside the EMS Billing and Software Investigation Part II: What Led to the $6 Million Dollar Write-off?

There is a disconnect between what the recently completed investigation into EMS billing finds and what the board was told leading up to a $6 Million Dollar write-off of bad debt last April....

As I wrote in part I of this series earlier this morning--some things that were told to board members ahead of a $6 Million Dollar write-off of noncollectable EMS bad debt last April do not match up with what the official investigation  has found.  This is troubling.

Taking a step back--it is troubling because we as elected board members are reliant on staff to give us accurate, timely, and complete information when required and when we request it--otherwise we cannot function properly and make good decisions on behalf of the citizens we represent.  It is very basic:  We are not the subject matter experts on all facets of operations--nor should we be.  Thus, we rely in large part on staff.  Decisions we make are only as good as the information we are given to make these decisions.

 And I know the feeling, firsthand, that comes when a board member finds he was deliberately misled and/or given incomplete information purposely....it is called a flashback to the Newpoint Charter Schools fiasco that occurred when I was a member of the Escambia County School Board and got wind of misinformation being given to the board and about resources being stolen from students.  I blew that open, went to the State Attorney, and some folks went to jail. Others avoided the scrutiny they deserved, and were very fortunate in the way the outcomes worked for them. That's the way that worked.  If anyone is interested in that, they can read all the posts about that issue here.

But that was five years ago, and that issue is over---so I digress.

Now we are talking about a nearly $6 Million Dollar write off of debt that was presented to the board as an issue caused by a "software glitch" caused by the EMS billing department cycling back and forth between two different software systems.

I'm confident that most of that $6 Million in bad debt was in fact debt from 2005-2017--I believe that.  But in analyzing the statements made by staff and responses to questions posed to staff from me and my counterparts, particularly answers given to Commissioner Barry--there is a disconnect about a portion of the debt being written off that does not square with what our investigation now reveals.  Much of the issue was caused by a "failure of management"to review workflow--not a software glitch issue.  The backup from that meeting item requests the write off of "13,668 accounts that have been through all phases of the billing and collection cycles, to include all primary and secondary insurance filing, private pay processing pre-collection letters, and/or referral to the secondary collection agency."  But the investigations states, as it pertains to these accounts, that "The required write-off of bad debt was attributed to a failure of management to continue to review and ensure the workflow for billing would be conducted in all billing systems." Importantly:  Did these accounts, in fact, ALL go through all primary and secondary insurance filing as was indicated to the board in our backup?  This is important, and I want to know.

And I remembered that "software glitch" term being a prominent part of the conversation between the board and members of PS leadership on April 4th during our agenda review session.  As a matter of fact I went back and watched that discussion multiple times today (minutes 40:00-55:00 of this link) and at multiple points it was said by staff that the issue was "Completely software driven"  I remember we had a very robust review of that issue with lots of questions for staff.  Looking at what was said then, and what I am reading today--the two do not square.

If it was completely a software issue--how come the investigator could not corroborate that claim with testimony or documentary evidence?

This is going to require a deeper dive next week, and this issue in particular will be one I will request our new administrator to look into as soon as possible.

The Board MUST have confidence that the information we are given is accurate, timely, and complete--even if the optics are unflattering.  If not, confidence is lost and the whole system will break down.

Inside the EMS Billing and Software Investigation Part I: What Are the Report's 2 Key Conclusion (s)?

The report on EMS billing and software issues is 32 pages of narrative and 70 pages of exhibits-but in the end two main conclusions are reached and described.  

This week the board members were all provided with a very thorough and well-written summary of the county's internal affairs investigation into the ESO/Zoll software switch ---and also the nearly $6 Million dollar write off of noncollectable EMS receivables we approved in April.

Upon obtaining a copy and reading the entire report, I spoke with legal staff to ascertain if anything uncovered in the report rose to the level of a criminal act, and I also asked if this report is a public record.

I was told the sustained findings in the report do not rise to the level of a crime, and due to the fact that the individual named in the report no longer works for the county, it is and will be up to the BCC to pursue any next steps regarding what was described in the report (e.g. whether or not to send the report to SAO).

Although legal staff has advised this document is a public record--as I read it I realized there are some items that should be redacted before release, so therefore I will heed the warning on the front cover of the report, above, and not link the document here as I had originally intended to do.

But I will discuss the two main areas covered in the report.

1.  According to the report, and based upon the evidence collected by the investigator, the acquisition of ESO software was done in contravention to BCC policy--as the total cost of the complete solution would have exceeded the $50,000.00 threshold for triggering a competitive bid for the software.  Because the purchase was apparently incrementalized to avoid going over the approved non-competitive purchasing threshold, the report indicates that numerous purchasing ordinances and the Escambia Code of Ethics were violated. (page 26, 27 of report).

2.  EMS billing issues and noncollectable write-offs were not completely the result of the failed software implementation/conversion from ZOLL/ESO/ZOLL--although this exacerbated the situation.  According to the report: "While there was a failure of the department to evaluate all end-users that could be affected by the EMS Operations ESO Solutions software implementation, the required write-off of bad debt was attributed to a failure of management to continue to review and ensure the workflow for billing would be conducted in all billing systems[emphasis added]."  and the last sentence of page 29 is really the key, and it is what I'll be looking into and describing in a follow-on post:  "Additionally, the reported 'overlooked accounts' or unbilled accounts caused by a 'computer glitch' represented to the BCC during the April 4, 2019 meeting, could not be supported by testimony or documentary evidence [emphasis added]"

Were we intentionally misled to approve the write off?