American Medical Response Evaluation Sheet Explanation

Comparative Selection Criteria

Management Experience: Highly Advantageous (3)

Location of Service: Highly Advantageous (3)

Participation in Emergency Planning: Highly Advantageous (3)

Legal Performance: Unacceptable (0)

  • The RFP criterion lists any “administrative or judicial proceedings being filed against the proposer or its principal officer(s) or agent(s) or employees, relating to operation of proposer’s ambulance business…” within two years as “unacceptable”. In May of 2011, American Medical Response agreed to settle an administrative action with the United States Department of Health and Human Services’ Office of the Inspector General. The settlement involved American Medical Response paying $2.7 Million to the United States and signing a Corporate Integrity Agreement.

Required Information

Signed Cover Letter: Incomplete (1)

  • American Medical Response failed to provide a signed cover letter which binds the company to the statements within their RFP.

Qualifications and Experience: Incomplete (1)

  • The RFP, in Section IV.D, requires vendors to include any information indicating if the vendor’s “firm has been dismissed or disqualified or withdrawn from a bid/contract within the past five years, and if yes, the reason(s) why”. American Medical Response did not include any information in their bid package relating to any such events. In December 2012, American Medical Response was terminated from their 911 contract by the Town of Plymouth, Ma. This termination was made under Section 1 of the contract between American Medical Response and the Town of Plymouth, which read, “Either party may terminate this Agreement without cause by one hundred and twenty (120) days written notice to the other party”. Additionally, in November of 2012, American Medical Response withdrew from its contract with Newburyport, Salisbury and West Newbury, Ma. This withdrawal was prompted, as stated by American Medical Ambulance, after wage concession negotiations with the National Emergency Medical Services Association union failed.

Minimum Qualification Criteria: Complete (2)

Acknowledgement of reimbursement: Complete (2)

Anticipated schedule of fees: Complete (2)

Listing of Insurance companies: Complete (2)

Acknowledgement of addenda: Complete (2)

Non-collusion Statement: Complete (2)

A list of references: Complete (2)

Interviews – Vendor Presentations

Management Competency: Excellent (4)

Financial Support and Stability: Good (3)

  • Vendor discussed the closing of the Newburyport operations as an economic move to cut costs.

Customer Billing and Service: Good (3)

  • In 2011 customer complaints over billing practices lead to a City audit of AMR’s Manchester billings. The findings indicated a problem with balance billing. This issue was much more widespread than previously thought. During the vendor presentations, it was positioned that the billing issue was a local one and that with the new management team these issues would not occur. AMR has established a local customer care office; however, the main corporate billing office in Akron, Ohio still processes all Manchester bills.

Contract Variables

Dispatch Reimbursement: Meets Requirements (2)

Oversight Reimbursement: Meets Requirements (2)

Usual and Customary Rates (UCR): Most Advantageous (3)

  • While CarePlus’ UCR rates were the lowest by $100 per category, American Medical Response did not propose a UCR charge for individuals where transport did not occur.

Medicare plus rates (Cost to Patient): Less Advantageous (1)

  • American Medical Response’s Medicare plus rates (29%) were higher than American Ambulance’s rates (25%), but lower than CarePlus’ rates (35%).

Total Evaluation Score

43

It is this evaluator’s opinion that the overbilling issue appears to be a systemic problem with American Medical Response. Reports of billing discrepancies were found which date back to 2002. AMR was listed in a National Press Club report of “The Top 100 False Claims Act Settlements” for a $20,000,000 settlement in a false claims allegation. In 2006, AMR paid the United States over $9 million to settle a claim that the company violated the False Claims Act in Texas. A 2010 payment of nearly $1 million was made by AMR to settle an overbilling claim in Spokane, Washington. More recently in 2011, AMR agreed to pay the United States a $2.7 million settlement to resolve allegationsof submitting inflated claims in New York. As a result of that settlement, AMR agreed to sign a Corporate Integrity Agreement (CIA). A review of the Office of the Inspector General’s CIA list revealed 314 active Corporate Integrity Agreements nation-wide since 2005. Of the 314 agreements, nine were from ambulance providers. American Medical Response was listed as one of the nine. Rockingham Regional Ambulance’s case was closed on May 3, 2013, thus reducing the list of ambulance companies to eight. It is not the intent of this evaluator to allege any wrongdoing on the part of American Medical Response, however, these examples serve, in this evaluator’s opinion, to illustrate the difficultly of a large, centralized corporate billing and collections operation to control and meet the various billing and collection requirements of local contracts. The range and breath of these billing issues appears to this evaluator to be a function of a larger corporate process, rather than a local management issue.

American Medical Response has been the nation’s largest ambulance provider for some time. Recently, however, there have been operational closings and contract withdrawals which have this evaluator wondering about the long term viability of AMR in the New England and Manchester market. During the vendor presentation, it was stated that the Newburyport operation was shut down for economic reasons. A search of federal WARN notifications revealed layoff notices for nearly 1220 employees in the Sacramento, Concord, San Jose, San Rafael and San Leandro, California areas between 2011 and 2012. This evaluator was unable to determine if those layoffs actually occurred. Contract terminations and non-renewals have also occurred in the NH and MA areas. Most recently, the New York State Department of Labor listed a WARN notification for layoffs of 148 employees of AMR in their Long Island and Brooklyn, NY operation. According to news reports, AMR will cease operations in Brooklyn on July 1 and on Long Island on September 1, 2013. This evaluator is concerned over the long-term stability and commitment of AMR to the New England and Manchester market.

It is this evaluator’s opinion that American Medical Response possesses the necessary local resources, management ability and skilled providers to meet the service delivery requirements of the Manchester emergency ambulance contract.

Based on the Comparative Selection Criteria, completeness of required information, vendor presentation and contract variables, this evaluator cannot vote to recommend American Medical Response as the 911 emergency ambulance provider to the Committee on Administration.

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