Finance director details ambulance service shortfalls; county and towns to revisit contracts

Finance Director Liana Pick told the Richland County Executive & Finance Committee on Oct. (date not specified in transcript) that the county-run ambulance service is carrying large receivable write-offs and is running a year-to-date deficit.

"The auditors decided ... approximately 40% of our receivables are uncollectible," Pick said, summarizing the audit work that produced an allowance for doubtful accounts of about $175,000 for older claims and an additional roughly $198,000 recorded for 2024. She said the county's average annual ambulance revenue from 2019–2025 is about $951,000 while average expenses are about $1,000,000, meaning the service typically operates at or near a loss. "We're spending approximately $100,000 a month to operate and run the ambulance service," she said.

Why it matters: those allowances and recurring deficits have reduced the ambulance fund balance from roughly $297,000 (Aug. statement) to about $108,000 in the most recent balance sheet Pick ran. If the books were closed today, Pick said, the fund balance would be about $75,000.

Nut graf — immediate next steps: Committee members directed county counsel to review a letter and documents related to the ambulance service and agreed to return the matter to the committee and the full county board for decisions on contracts and funding. Andy Phillips, the county's corporation counsel, will review the informed-consent/contract letter and related documents and the item will be placed on the Executive & Finance Committee agenda on Nov. 11 for further action.

Details from the presentation

- Accounts receivable and allowance: Pick showed audited work and internal reports indicating large uncollectible balances concentrated in older receivables (2016–2022). She said auditors used historical collection data to set the allowance; that methodology led to the 2023 entry of about $175,000 and the 2024 increase of about $198,000. Pick said the auditing approach is consistent with generally accepted accounting principles.

- Current-year receivables and direct write-offs: County records show the third‑party billing contractor has submitted monthly direct write‑offs of $20,000–$40,000 for 2025. The finance director also said there is a discrepancy between the billing company’s figures and the county’s Tyler ERP reports; she said she will investigate and provide reconciled reports.

- Revenue and reimbursement dynamics: Multiple speakers (committee members and others) explained that ambulance bills are submitted at a full charge rate so government payers (Medicare/Medicaid) and private insurers can adjudicate claims; the net collected amount is frequently much lower than billed. One committee member summarized that billing at a high charge is necessary to obtain the maximum reimbursement from Medicare/Medicaid, which then often reduces the collectible amount.

- Patient responsibility and collection limits: Pick noted roughly $178,000 in "patient responsibility" for 2025 in the billing vendor's summary, and highlighted limits on collection efforts (auditors described a modest collection contact standard — two phone calls and a letter). Pick said the county may need to evaluate collection practices and whether the billing vendor’s collection efforts should change.

- Contract rates, proposed town contributions and budget: Pick presented prior contract volumes and proposed contract rates and a draft 2026 ambulance budget set at about $1.3 million. The 2026 budget includes an allowance for uncollectible receivables (the draft budget assumes about $400,000 in uncollectible amounts). She also modeled a hypothetical household charge (an example: $30 per household per year) that would increase revenue if municipalities adopted such an approach.

- Call volume and service changes: Pick and committee members noted 2025 call volume is higher than in earlier years (about 1,162 calls in 2025, per the packet), and that inter‑facility transport volume changed year to year; 2023–2024 had higher transfers than 2025, in part because the county used temporary staff to cover transfers previously.

Discussion and next steps

Public commenter Shirley Welty (Dayton Township representative) said she was "excited to learn more" and asked that more clear call-data and receivables information be shared with the joint ambulance committee. Several committee members asked for reconciled monthly reports tied directly to the county’s Tyler ERP system.

The committee and staff agreed on these immediate actions: county counsel (Andy Phillips) will review the letter from the ambulance provider’s attorney and related documents and will contact the provider’s counsel if needed; the ambulance financial review and possible contract options will return to the Executive & Finance Committee on Nov. 11; staff will produce reconciled, month‑by‑month statements pulled directly from Tyler and a clearer receivables aging schedule for committee review; and county staff will arrange informational sessions (including invitations to James Small at the UW system rural health program and local municipal officials) to present options before the full county board makes any funding decisions.

Direct quotes from the meeting

- "I am excited to learn more about the ambulance service update," public commenter Shirley Welty said during public comment.

- "The auditors decided ... approximately 40% of our receivables are uncollectible," Finance Director Liana Pick said of the auditors' allowance calculation.

- "We're spending approximately $100,000 a month to operate and run the ambulance service," Pick said when describing operating costs.

Clarifying details and numbers from the presentation

- Auditors' allowance recorded for pre-2023 receivables: about $175,000. - Additional 2024 allowance increase shown in audited entries: about $198,000. - County average invoiced revenue (2019–2025): ~$951,000 per year (gross billed amount). - County average expenses (2019–2025): ~ $1,000,000 per year. - Operating cost estimate cited in meeting: approximately $100,000 per month. - Draft 2026 ambulance budget presented: $1,300,000 (includes allowance for doubtful accounts). - 2025 call volume presented in packet: ~1,162 calls.

Speakers (selected, named in transcript)

- Liana Pick — Finance Director, Richland County (government) - Shirley Welty — Public commenter, Dayton Township representative (citizen) - Andy Phillips — Corporation counsel / county attorney (government) - Mike Windle — Attorney who notified county he would step down from representing the ambulance service (other) - Tammy Newberry — billing/finance staff referenced by county staff and finance director (government/finance staff) - Barb — Treasurer / county official who receives billing reports (government) - Jeff — Ambulance committee member / local EMS stakeholder (citizen) - Dave Turk — County official who met with counsel and staff about the matter (government) - Britney — Pine Valley representative (government)

Authorities referenced

- Generally accepted accounting principles (GAAP) — referenced by staff describing auditor procedures (type: other). - Medicare/Medicaid reimbursement rules — mentioned as determining net collectible amounts from billed charges (type: regulation/other). - Tyler — county ERP system used for accounting and reporting (type: policy/other). - Board/attorney letter from Boardman Clark (attorney/client correspondence referenced by staff) — referred to in discussion of counsel review (type: other).

Actions extracted (documented directions, not formal votes)

- Motion/Direction: County counsel (Andy Phillips) will review the attorney letter and informed-consent materials related to the ambulance service and will contact the other side's counsel as needed; item to return to Executive & Finance Committee on Nov. 11 for additional consideration. Mover/Second: not specified in transcript. Outcome: postponed for counsel review and return to committee. Notes: transcript records committee agreement to have counsel review and to return item to Nov. 11 meeting.

- Action: County posted an RFP for corporation counsel for 2026; proposals will be opened at the Nov. 11 committee meeting (administrative direction from staff report). Outcome: staff will review proposals on Nov. 11.

Community relevance

- Affected geographies: Richland County; municipalities and townships that purchase ambulance coverage (Pine Valley was singled out in modeling). - Impact groups: residents served by the ambulance service (including uninsured or underinsured patients), participating municipalities and townships, county taxpayers.

Meeting context

- Engagement level: deep, data-heavy review by finance staff with multiple questions from supervisors, committee members and public comment (dozens of minutes of presentation and discussion). - Implementation risk: medium — changes to contracts, municipal buy‑in or a new funding mechanism would be required to materially change the service's finances. - History: item builds on prior joint ambulance committee work dating back to earlier discussions this year; packet materials included prior-years data and prior agreements.

Searchable tags: ["Richland County","ambulance","EMS","accounts receivable","budget","Tyler ERP","Andy Phillips","municipal contracts"]

Provenance: topic spans the transcript from the start of public comment on the ambulance item (public comment from Shirley Welty at transcript time ~82.54–176.57) through the finance director's presentation and committee discussion (roughly transcript time ~729.34–3678.35).