N.C. Bill Would Help Counties Collect on EMS Charges

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Mar. 5--RALEIGH -- A state legislator filed a bill yesterday that would make it easier for counties to recoup payments from people who use county-ambulance services.

State Rep. Dale Folwell, R-Forsyth, is trying to crack down on a trend that Forsyth County officials say has cost the county about $400,000 over the past three years.

When a Forsyth County ambulance takes a patient to the hospital, the county bills the patient several hundred dollars for the cost of the trip. Most health-insurance companies pay that bill on behalf of the patient by sending a check directly to the county.

But the state's largest health insurer, Blue Cross and Blue Shield of North Carolina, sends a check not to the county, but to the patient. The patient is supposed to forward the payment to the county, but some patients don't do that. Since the check is made out to the patient, the patient can cash it, pocket the money, and the county never gets paid. "People have figured this out, and now what's happening is we've got several patients who basically use it as extra income," said Dan Ozimek, the director of Forsyth County EMS. "We've got people who owe thousands and thousands of dollars."

Folwell and Ozimek cited anecdotal evidence of people who are taking advantage of the loophole. A 55-year-old woman in Forsyth County requested an ambulance 22 times in 2008 and racked up $12,449 in ambulance bills. She collected that money from Blue Cross but never paid any of it to the county, and she does not respond to communications from the county.

The woman is retired from the local school system and is a member of the State Health Plan, which is administered by Blue Cross.

Other counties across North Carolina are having problems similar to Forsyth's.

Blue Cross says that it doesn't pay a county directly if the county's EMS is not in the Blue Cross network of providers. If Forsyth County were to join the network, it could get paid directly -- but the network reimbursement for ambulance services would likely be lower than what the county currently charges.

Folwell's bill tries to reduce the problem by focusing on the State Health Plan, the health-insurance plan for 667,000 state employees and retirees.

The bill would require the State Health Plan to issue ambulance payments as "co-payable" checks listing both the name of the patient and the county EMS. An ambulance patient would have to co-sign the check and then send it to the county before the check could be cashed. That would prevent patients from pocketing the money for themselves.

"It should lower the cost of operating the State Health Plan, and it will definitely make it easier for counties to get the money they so badly need," Folwell said.

The bill, however, is limited in scope: It applies only to members of the State Health Plan and would not affect payments for any other Blue Cross policyholders.

Ozimek said that Blue Cross knows that some of its policyholders are abusing the system. "These individuals are fraudulently using their insurance company to supplement their income," he said. "As far as I'm concerned, Blue Cross is an accessory to insurance fraud."

Lew Borman, a spokesman for Blue Cross, said that the company has an ambitious department that investigates fraud, and he said that anyone suspecting fraud should report it.

"We would welcome the opportunity to sit down and explore these concerns and investigate them," Borman said.

He said that the company is still reviewing Folwell's bill. Because the bill is directed at the State Health Plan, Borman deferred any further comment to officials at the plan.

Two spokespersons for the State Health Plan could not be reached yesterday afternoon.

James Romoser can be reached at 919-210-6794 or at jromoser@wsjournal.com.