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Commissioners probe $10.26 million in ambulance uncollectibles; no write-off vote taken
Summary
County staff and commissioners discussed a large, aged accounts-receivable balance in ambulance billing tied in part to a prior vendor's data problems and to payer mix; they asked legal and finance to explore collection options and safeguards but did not authorize a specific write-off at the meeting.
Flagler County commissioners spent substantial time questioning staff and fire-rescue leadership about a $10,258,142.01 balance in aged, uncollectible ambulance accounts that appears in records from June 2018 through February 2024.
Finance and fire-rescue staff said a major portion of the balance is tied to billing handled by a previous vendor, Change Healthcare, where staff reported a cybersecurity incident and data problems during a transition in billing vendors. Commissioners and staff said the county moved billing to a new vendor, Digitech, and that collections have improved under the new company. Fire-rescue leadership said industrywide collection rates for ambulance transport often run near 60 percent, because Medicare and Medicaid pay fixed, contracted amounts that are frequently below billed charges.
County financial staff reported management had not earlier pursued third-party collections for many of the accounts and characterized the proposed action as a management decision to address long-standing, aged receivables. Commissioners asked whether legal had reviewed the matter and whether the county had exhausted remedies against the previous vendor, insurance, or class-action avenues. County counsel and staff agreed to consult legal counsel about potential remedies tied to the former billing vendor and to evaluate collection policy options going forward.
Staff said some of the unpaid balances include patient deductibles and partial payments after insurer remittance. Commissioners urged establishing a clear policy for how long to attempt collection before accounting for uncollectibles; suggestions included moving accounts to collections after 180 days or conducting an annual cleanup to avoid long-term accumulation on the books. Fire-rescue leadership said the new vendor has doubled recent collection performance compared with Change Healthcare, but commissioners nonetheless pressed for written policy and periodic write-off practices so accounts receivable reflect collectible values.
No formal vote to write off the $10.26 million appeared in the transcript. Instead the board directed staff to consult with finance, fire/rescue, and legal to review collection options, Medicare audit risk and reporting, and to propose policy changes on collection thresholds and timing.
Clarifying detail: staff cited $10,258,142.01 in uncollectibles from June 2018 through February 2024 as the figure under discussion.
