"SJI EMS disagrees with nearly all of your assertions." That is the response from the attorney representing San Juan Island Public Hospital District in the Civil Investigation by the Attorney General's Office alleging medicaid fraud. The PHD oversees SJI EMS.
The AG's Office had told the PHD that the investigation revealed more than 400 improperly filed claims. The state claimed it found problems in four categories: "These categories all stem from the same troubling conduct—SJI EMS never made any independent assessment of whether these fixed-wing transports were appropriate or medically necessary, and instead affirmatively and repeatedly chose the most expensive mode of ambulance travel available. SJI EMS's conduct of routinely billing the State for the highest level of transportation, irrespective of the underlying circumstances, contravened multiple rules and regulations of the State's Medicaid program (e.g. WAC 182-546-4000, 5000 et seq. )."
According to the state, the fine would have been in excess of a million dollars but they would settle the case for $350,000. If the case continued and all of the claims were determined to be fraudulent, with treble damages the fine could be as high as $13.6 million.
According to the letter from PHD Attorney Jim J. Fredman, "SJI EMS lost nearly $3000 per flight. SJI EMS simply had no financial incentive to fly Medicaid patients via air ambulance. SJI EMS was solely driven by the need to ensure that the patients received necessary treatment in a timely manner and that no patient’s condition was put at risk due to a delay in transportation to the appropriate hospital."