Audit office finds billing and control weaknesses in fire-department contractor and gaps in SAPD/Metro Health crisis-response procedures

The San Antonio Audit Committee on June 10 accepted two audit office reports that identified weaknesses in fire-department billing controls and in SAPD/Metro Health crisis-response team (CRT) operations, training and access controls. Committee members asked questions about budgeting, data and follow-up; both departments agreed with the auditor recommendations and proposed corrective-action timelines.

Abigail (Abi) García, Audit Manager, presented findings from a review of the fire-department contract used for patient-care billing. The auditors found gaps in controls that prevented the city from charging for some administered medications and other services. The presentation said certain medications were not configured in the billing system, that epinephrine-related entries were inconsistently billed, and that transportation fees were not always applied where required. The auditors recommended revising medication lists, coordinating with the regional system owner to align controls and improving supervisory review and data-monitoring to identify missed charges. The city and the fire department agreed to a corrective-action plan that the auditor said is expected to be completed by October 2025. Abigail García concluded: "Eso concluye mi presentación." ("That concludes my presentation.")

Committee members asked how changes in billing and data accuracy might affect departmental budgeting and whether correcting billing would change demand for emergency medical services. A fire-department representative said correcting the billing will improve data used for operational decisions and help the city understand service levels, but staff did not predict large changes in service demand solely from billing corrections.

The committee then reviewed an audit of San Antonio Police Department (SAPD) and Metro Health operations for the Crisis Response Team (CRT). Michael Gutiérrez, Audit Manager, summarized that the audit found CRT metrics were generally reported, and case documentation was maintained, but that operations did not consistently follow policies and procedures. Specific findings included incomplete training records for some CRT members, inconsistent completion of an initial danger-assessment form (referred to in the presentation as the "Dale" form), inadequate supervisory monitoring of assigned CRT tasks such as victim contact and follow-up, and inappropriate physical and electronic access to sensitive case records containing protected health information (PHI).

The auditors recommended ensuring training completion, requiring the initial danger-assessment form be completed for each case, strengthening supervisory monitoring of CRT tasks, and tightening access controls to limit inappropriate physical and electronic access. Management from SAPD and Metro Health agreed with the recommendations and are developing action plans, which the auditor said are expected to be complete by October 2025.

Committee members asked about how the danger-assessment form is being enforced and whether personnel making risk determinations have appropriate training; audit and police representatives said the reporting system was modified so an officer cannot submit an incident report until the danger-assessment form is uploaded, and that recent training sessions were held though some records had not yet reflected completion signatures.

The committee voted to accept both audit reports. Members also praised ongoing community outreach and prevention work with Metro Health and asked for future briefings on training, follow-up performance and data the council can use when considering budget decisions.

The meeting adjourned following expressions of appreciation for a departing councilmember.