Supervisors return EMS money

Amissville volunteers upset about losing reimbursements for Culpeper calls

There were no smiles beneath the iconic moustaches of local fire and rescue volunteers Monday (Jan. 4), as they evacuated the Washington Court House following a roll-call vote by the Board of Supervisors (BOS). An angry wind whipping the frozen trees outside met them as they streamed through the big doors in disgust.

Nearly $40,000 generated by the Amissville Volunteer Fire and Rescue (AVFR) company in the last two years, re-imbursement for making service calls to Culpeper residents, will be given back to ten insurance companies.

A motion to return $38,103.35 to a billing company hired by the county passed by a 4-1 margin, with Jackson district supervisor Ron Frazier the lone dissenter. That money will be electronically transferred to billing company Fidelis, to be divvied up and returned to Medicare, Medicaid and several other insurance companies that had already paid the county for the service provided by AVFR.

Attorney David L. Konick, representing the AVFR on a pro bono basis, repeatedly challenged county attorney Peter Luke and county administrator John McCarthy during the meeting, arguing that the county has no authority to receive money for services provided by a volunteer organization that owns its equipment and makes its own runs. And therefore, Konick insisted, the money at issue shouldn’t be the county’s to either keep or give away.

In May 2013, the BOS passed an emergency medical services (EMS) cost-recovery ordinance, which allowed the volunteer fire and rescue companies to bill insurance companies for providing service to their clients. If someone were in need of emergency service but did not have health insurance, they would not be billed.

The ordinance was passed, according to county attorney Peter Luke, to generate funds for the various volunteer fire and rescue companies over-and-above the tax revenue drawn from the county fire levy. Aside from the tens-of-thousands being disputed, over $120,000 went to the county for calls made by volunteer fire and rescue companies within county borders. That money goes into the county general fund, to be disbursed to various entities via BOS appropriations based on a point system.

However, nothing in the ordinance specifies billing calls made to citizens in surrounding counties — and as a symptom of geography, sometimes a Rappahannock company can more quickly respond to a call in an area just outside county lines than a company in that county. Luke says neither the volunteer companies nor the county have authority to charge citizens of another county, or their insurers, for providing service outside Rappahannock borders.

“Firemen don’t pay too much mind to political boundary lines when they rush out of bed at two in the morning to save you,” Konick said in a follow-up interview Tuesday evening. “It seems like they’re more interested in saving people’s lives.”

Konick introduced a resolution to the county’s emergency medical services cost-recovery ordinance passed by the BOS in May 2013, which was ultimately dismissed after more than an hour of frustrated discussion.

The resolution cites a Virginia code section which specifically provides and requires that any person providing services to a person put under a policy that is billed shall receive reimbursement for the services.

“So in this circumstance, the county is not providing that service,” Konick said. “The [entity] providing that service is the responding company. And under that statute, which was cited as the basis of your own ordinance, they’re the ones who are entitled to the money, not the county.”

The resolution would specify cost-recovery for out-of-county calls.

“Here in Rappahannock, these people are volunteers affiliated with an independent corporation. That’s a legal entity that has no agreement, through the [Rappahannock Volunteer] Fire and Rescue Association or otherwise, with the county,” Konick declared Monday, standing before the BOS and between several visibly disgruntled volunteer representatives of his client. “So how the county subsumed this authority to bill at all. They billed for our calls. Whether they did it rightly, wrongly, in violation of the ordinance or not, they billed for Amissville’s calls and they collected the money. You’ve got the money. And all we are asking for is to give Amissville the money that they’re entitled to under state law.”

Luke disagreed, saying that each volunteer fire and rescue company entered into a contract with the county in 1998, and therefore must adhere to county ordinances. AVFR billing for calls outside the county, Luke said, goes against the county EMS ordinance.

The contract is called the fire services agreement, whereby each of the individual volunteer fire and rescue companies agree to provide volunteer fire and rescue services for the citizens of Rappahannock County. In exchange for which the BOS, by state law, is entitled to extend its sovereign immunity for them performing those services.

“Sovereign immunity basically says that if they’re in good faith conduct in attempting to rescue someone or save someone’s life, they can’t be sued,” McCarthy explained Tuesday. “So sovereign immunity is an important thing to induce volunteers to participate in a volunteer fire and rescue program, so their lives aren’t ruined if something goes wrong.”

An important aspect of the adopted EMS cost-recovery ordinance, McCarthy said, is that it guarantees that the county and its volunteer companies are playing by the federally-regulated rules of Medicare relating to fraud. Both Luke and McCarthy foresee surrounding counties either following suit or running into serious trouble if audited by the federal government and can’t justify receiving the money for making out-of-county calls.

“The death blow from Medicare, which I admit is a very low probability, would be to lose your Medicare number so that you’re no longer able to bill Medicare,” McCarthy continued. “They don’t do that very often. What they do is, for any amount of money that’s in contention, that they claim you fraudulently billed for, there is a three-times penalty. So if you keep a thousand bucks you’re not supposed to keep, and they reasonably conclude that you shouldn’t keep it, you have to give that thousand bucks back, and they fine you $3,000. So it’s expensive. Is it likely? Again, that’s a gambler’s bet. The better bet is to just not play the game, to just keep your hands clean. If they do find out, bad things happen.”

Frazier’s motion to allow AVFR to keep the money died at the table, for lack of a second. Hampton district supervisor John Lesinski followed with a motion to return the money to Fidelis, and ultimately the insurance companies. Stonewall-Hawthorne district supervisor Chris Parrish seconded the motion, which was then set to a vote.

“I feel sorry for Amissville,” Luke said. “I wish I could tell you to go ahead and take the money and forget about it, but I can’t tell you that. At risk is your Medicare number. If something bad happens and you lose your Medicare number that means you can’t go for anybody. So I think my interest is to advise you of what is in the best interest for the county. And if they [the federal government] audit us and say ‘What’s your authority to charge these Culpeper citizens $38,000?’ Then what do we say? That ordinance says that we will charge our own citizens only.”

Just before the vote, Parrish noted that it is crucial for the county to gain and maintain volunteers.

“How are they going to do that when they take money from our company for us doing our jobs?” an angry volunteer said under his breath in the back row of the courtroom, shoulder-to-shoulder with Konick and several volunteer fire and rescue personnel, before the 30 or so spectators filed out of the courtroom, only partway through the meeting.