Palm Beach County commissioners direct staff to pursue collections for $12.1 million in unpaid EMS transport bills

Palm Beach County commissioners on Oct. 7 signaled they want staff to pursue collection of long-unpaid emergency medical services (EMS) transport bills—while asking for more data and a policy that includes relief pathways for residents who cannot pay.

Commissioners discussed an estimated $12,100,000 in proposed write-offs for EMS transports, with roughly $8,422,611 categorized as “self pay” (no insurance information attained or nonpayment). The board did not adopt an immediate ordinance or contract change; instead it directed staff to develop policy options, gather more detailed data on repeat users and payer breakdowns, and return with recommendations.

Why it matters: Commissioners described the unpaid balances as taxpayer dollars left “on the table” and asked staff to balance collection with safeguards for indigent residents. Several commissioners insisted any collection program include a clear process to request relief or appeal, and they asked for better patient contact data and hospital coordination to improve billing success.

Officials and numbers: Lauren Majrowski, finance director for Palm Beach County Fire Rescue, told the board the county’s third‑party collections vendor, Valley, has been under contract since December 2024 and typical collection rates for comparable vendors range from 2% to 11%. Majrowski said, “If we were going to collect any of that, let’s just say 2% or so, we would be looking around dollars 233,000 of the 12,000,000.” She gave the current billed transport rates as $730 for basic life support and $890 for ALS 2 transports.

Philip Oliveira, division chief of medical services, confirmed that some people are frequent users of 911 transport—“sometimes it could be every week”—and that the county follows up with a Mobile Integrated Health team in some cases to reduce repeat calls.

Board concerns and next steps: Commissioners repeatedly pressed staff to explain the composition of the self‑pay bucket and whether hospitals provide follow‑up patient information. Commissioner Wise estimated the unpaid self‑pay count could represent roughly 10,000 transports (about 30 per day) under the $730–$890 charge range and asked staff to investigate whether hospitals and Digitech, the county’s billing system vendor, are improving data capture.

Staff said Digitech’s platform improvements since December 2022 have raised the collection rate from about 65% three years ago to roughly 69% most recently, and that the county keeps accounts active for three years before writing them off. Commissioners requested a more granular breakdown (counts by dollar bands, number of repeat users, numbers attributable to deceased patients or estate collections) and evidence that recent vendor/system changes are reducing write‑offs.

The board’s direction: Rather than an immediate vote to send outstanding EMS balances to collections, commissioners directed staff to return with a policy menu including (1) targeted collections for self‑pay accounts, (2) options to pursue third‑party collections under existing contracts, (3) an application or appeal process for financial relief, and (4) more complete reporting on repeat users and hospital coordination. The county administrator and staff said they will prepare policy options and fiscal impacts for a future meeting.

Ending: Commissioners said they want to treat the county “like a business” in collecting revenue while preserving mechanisms to protect residents who truly cannot pay. The board did not adopt any ordinance or contract change at the meeting; staff will return with the requested analysis and policy recommendations.