Audit finds high collection rates for EMS billing but flags vendor adjustments and HIPAA training gaps

Internal audit presented a data-driven review of EMS transport billing and collections covering January 2023 through October 2025. Auditor Jevin Matthew reported that EMS responded to nearly 35,000 billable incidents and that net charges totaled about $17.3 million, of which $11.8 million (68%) was collected and deposited to the city.

Matthew told the committee that the contracted third-party billing vendor initially billed about $22.7 million but adjusted claims downward by roughly $5.4 million after insurance rules and eligibility reviews; the vendor also issued refunds of about $110,000. He said the city’s review process focuses on deposit totals and commission calculation but does not consistently verify the vendor’s adjustments or generate sufficient reports to reconcile adjustments. "The vendor initially billed to 22,700,000 based on the level of medical care provided. Upon review... the vendor adjusted a number of bills reducing initial charges of initial charges by 5,400,000," he said.

Audit recommendations include amending the service agreement to require periodic SOC 2 Type 2 (or equivalent) reports from the vendor, implementing periodic spot checks and quarterly monitoring procedures to verify level-of-care coding and adjustments, and instituting recurring HIPAA privacy/security training for personnel with access to protected health information. Management concurred and outlined an implementation timeline (various items complete or expected by June 2026).