Lee County officials admitted Thursday they violated federal rules by billing patients for $2.9 million they shouldn’t have for medical flights.
Lee County Public Safety Chief Kim Dickerson, in an email to county commissioners, said the county failed to meet federal safety standards required to bill patients.
Dickerson last month said the county was suspending its emergency medical flight program, Medstar, to pursue a voluntary accreditation from an out-of-state company.
Thursday’s admission came after several News-Press public-records requests to investigate the suspension.
Commissioner Frank Mann criticized management’s handling of the program and its shutdown after he was briefed on the matter Thursday by county management.
“I’m not at all pleased about how events relating to Medstar have come to light,” Mann said. “I think the commission should have been informed much earlier, as these problems were developing.”
The county will look to refund $320,586 to patients and insurance companies who paid for medical flights, according to Dickerson’s email to commissioners.
Presumably, the county will also notify patients and insurance companies that they don’t have to pay county bills for the remaining $2.7 million in flights.
Dickerson, Assistant County Manager Holly Schwartz and Commissioner Tammy Hall, who also was briefed Thursday by county management, didn’t return phone calls Thursday.
In addition to unauthorized billing, county management also gave free flights between Oct. 27, 2011, and Feb. 8 of this year. Those flights total roughly $430,000 in services that could have been billed, according to documents and Dickerson’s statement.
The dubious billing and free flights were a result of the county’s failure to comply with Federal Aviation Administration certifications for its Bell 430 helicopter — the county’s newer and primary helicopter since October 2011.
“The FAA has no information that the Bell 430 was flown on air ambulance flights in revenue service,” according to an FAA statement.
Pilots never were qualified to fly the helicopter for billing purposes, because county management fumbled with federal regulations and training requirements. It took the county more than 14 months from the time it purchased the helicopter in November 2010 to create operating and maintenance programs that met FAA standards for billing, according to the FAA.
“To the FAA’s knowledge, no pilot operated the Bell 430 in revenue service, so no violation occurred,” according to the FAA statement.
In her statement, Dickerson alleges county management was told by “Medstar Operations” that it could start billing for flights Feb. 9, 2012.
Former Medstar pilot Arnold McAllister disputed that. He said he and other pilots repeatedly told both Dickerson and Public Safety Director John Wilson during staff meetings that the county wasn’t allowed to bill for flights in the helicopter.
“Every one of the aviation people brought that up over and over again,” McAllister said. “Our concern was if they weren’t recovering any of the costs, they were going to start talking about cutbacks.”
When specifically asked about illegal billing and FAA violations by The News-Press on Aug. 24, Wilson said he had no knowledge of the matters.
“I’m going to have to get back with you on that,” said Wilson, who added then he was busy dealing with Tropical Storm Isaac.
McAllister said he also asked management about billing patients flown in the county’s auxiliary helicopter more than $8,500, while not being able to charge patients flown in the county’s primary helicopter, the Bell 430.
The county has had several run-ins with FAA regulators over the past few years.
“Relationships with the FAA representatives are characterized as hostile, argumentative and threatening,” according to an Aug. 15, 2011, report the county paid an independent consultant to perform.
That report sought to blame the county’s conflicts with federal regulators on Medstar’s former director of operations, Rick O’Neal.
When the program was suspended last month, Dickerson blamed the director of operations who replaced O’Neal, Rob Fulton. She said Fulton was incapable of bringing the program up to the standards of the voluntary accreditation.
At the end of 2010, the FAA sent the county four warning notices for violating eight federal regulations in three instances, according to FAA documents and FAA Spokesman Roland Herwig.
The violated rules pertain to the county’s pilot training program, record-keeping and maintenance procedures, according to FAA documents.
County officials claimed they do not have any record of the warning notices, in response to a request for public records.
The county’s most recent run-in with the federal regulators came in May.
FAA Principal Operations Inspector Paul Kahler informed county officials that Fulton was conducting pilot training with expired credentials
As a result, the FAA stripped a pilot’s certification that the county needed to bill for flights in the auxiliary helicopter and invalidated several other flight-training sessions.
McAllister reported the expired credential to the FAA, after Fulton refused to report it, according to emails. Fulton asserted that McAllister was “throwing out an accusation” before “going up the chain of command.”
County management retaliated against pilots who reported violations to the FAA, said McAllister, who was appointed to file quarterly reports with the federal agency.
“I was forbidden by Chief Dickerson and John Wilson from having any contact the FAA,” he said.
A few weeks after McAllister reported the expired credential to federal regulators, he said, county management placed him on leave and launched an investigation into his actions during one flight.
“Every time I warned them about a violation, the FAA would eventually come down and find it,” McAllister said. “They assumed that I had told the FAA about it, but I didn’t. The fact that I had been doing this for so long, I knew what the FAA checks for.”
Despite the various violations of federal rules, Dickerson insisted the program was suspended last month to seek a “national accreditation” from the Commission on Accreditation of Medical Transport Systems.
The accreditation is voluntary and no other government entity in Florida has it.
The organization’s director, Eileen Frazer, said because the county suspended flights, it will actually take longer to receive an accreditation. Frazer said the county will need at least a year of up-to-date flight logs before it can be considered for an accreditation.
“We’ve never had this happen,” Frazer said. “We’ve never looked at a program that wasn’t in service for the previous year. That’s just not what we do.”
Now, Dickerson says the county will consider privatizing, maintain the current model or enter a public/private partnership. The options will be presented to commissioners in November.
The idea comes after the county spent about $5 million in 2010 to buy the new helicopter and build a new hangar for Medstar at Page Field.
Last month, the county convinced the company Aeromed to move a helicopter that had served residents of Hendry County to Page Field.
The decision left residents of the rural community without a helicopter in emergencies. The nearest hospital with a trauma center, Lee Memorial, is more than an hour drive from the Hendry County seat, LaBelle.
Hendry Public Safety Director Randy Bengston had said it was smart move for the company because Lee County has far more medical flights than 70 conducted in Hendry last year.
“It’s a business decision, we understand that,” Bengston has said. “If (Aeromed) can help us, they will. If not, we’ll just transport by ground. There’s nothing else we can do.”