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Audit finds billing gaps in SAFD EMS contract; Audit Committee accepts corrective-action plan
Summary
The Audit Committee accepted an Office of the City Auditor report (AU 24-014) on June 10, 2025 that found billing inaccuracies and control gaps in the San Antonio Fire Department's EMS billing contract, and the department agreed to corrective actions due in October 2025.
The Audit Committee on June 10, 2025 accepted the Office of the City Auditor’s report AU 24-014 examining the San Antonio Fire Department’s EMS billing contract. Abigail Estevas, the audit manager for the project, told the committee that auditors “determined that fire did have adequate procedures to verify the accuracy of both the collections rate and the amount that was paid to the contractor BMP,” but identified specific billing and control weaknesses after analyzing six months of data.
Estevas said auditors found five types of billing inaccuracies: the approved medication list did not include rates for all medications (preventing billing for those medications); epinephrine was not consistently billed because of differences in naming conventions in the billing system; multiple dosages administered were sometimes billed only as a single dose; non-transport “aid-only” services were not consistently assessed the $100 fee; and some transport services were not billed the $1,000 transport fee that applied at the time of audit. She recommended the city review and update the approved medications listing, work with the South Texas Regional Advisory Council (the system owner of the ImageTrend application) to address front-end system issues, and develop monitoring controls to detect billing issues moving forward.
The audit also identified control weaknesses in ImageTrend user access and in subcontractor insurance coverage. Estevas said the Fire Department agreed with the recommendations and developed a corrective-action plan with an anticipated completion date of October 2025.
San Antonio Fire Department leadership told the committee they expect the corrective actions to “improve and refine the data” used for operational and budgeting decisions. A department representative estimated an average EMS response cost in the roughly $2,400 range when factoring overall budget and cost-recovery variables; the representative said fees the city charges are a partial recovery of total costs. Council members requested a more detailed breakdown of EMS budget, recoveries and write-offs for committee and council consideration during the budget process; the fire department said it would provide that information to committee members.
The committee moved to accept the audit report and the motion carried by voice vote.
