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Baraboo ambulance plagued with unpaid bills during deployment of key staffer

Baraboo District Ambulance Service
Baraboo District Ambulance Service in Baraboo.

BARABOO (WKOW) -- Underpaid, understaffed and underfunded: Baraboo's ambulance weathered chaotic finances for 13 months without a key employee, according to a new audit of the EMS provider obtained by 27 News.

From June 2018 to July 2019, Jessica Seefeld, billing coordinator for Baraboo District Ambulance Service (BDAS), left her day job for a military deployment to the Middle East. Upon her return, she found uncollected bills, payments not recorded and the financial reporting structures in disarray.

Over the following months, BDAS would ask the city of Baraboo, the largest community in the emergency medical service's coverage area, for an increase in its annual contribution. The municipality agreed but said it would withhold some of the money until an audit could illustrate the scope and causes of the ambulance provider's financial issues.

The city hired Chicago-based tax and advisory firm Baker Tilly Virchow Krause to look at the district's apparent problems managing and reporting its finances in Seefeld's absence.

The audit pulls few punches in its meticulous and lengthy assessment of how so much went wrong in just over a year.

Underpaid

Without its billing coordinator, Baraboo EMS missed out on charging hundreds of thousands of dollars worth of services and then failed to follow up and collect on many of the invoices it did issue.

In 2018, the year Seefeld's deployment began, BDAS billed $800,000 less than it had the year before. That's money Baraboo EMS relies on.

During that same period, Baraboo's ambulance service billed nearly $73,000 less per month. The charges almost completely rebounded when Seefeld returned to work.

The amount charged for each EMS call decreased by $150 while the billing coordinator was away, a problem the audit attributes to staff using the wrong billing codes when they entered needed payments into their tracking system. The incorrect charges quickly added up over the course of the estimated 4,500 calls the district's ambulances respond to every year.

The report also noted that 911 calls usually bring in less money for the ambulance service and, coincidentally, it had to respond to a greater share of emergency situations as opposed to nonemergent dispatches.

Had Seefeld not been called to active duty, the auditors estimated the Baraboo area's EMS should have had about $700,000 in unpaid charges from the months she was deployed. That amount is typical in the regular flow of billing and awaiting payments.

But in this case, more than $1.1 million remained outstanding as of mid-November.

The ambulance service is unlikely to recover some of that money because, as the audit notes, many insurance companies and government programs BDAS bills have deadlines as to when they need to receive invoices. In other words: If they are not billed in a timely fashion, they will not pay.

Prior to her deployment, Seefeld had done much of the follow up to make sure outstanding bills were addressed.

After she left, the amount of time before the service received significant payments shot up from just over four months to 14.

The exact amount of money the ambulance service will never get is unknown, but the auditors do note their estimates are likely low, meaning BDAS could be missing even more funding. Given these "low" figures, some $200,000 has not been collected.

The auditors said it would take "extensive" work to figure out exactly how much money was lost.

Seefeld told 27 News she hadn't expected the district's finances to go awry in her absence, but also was "not surprised."

Understaffed

The report repeatedly highlights that no one on staff seemed prepared to take over for Seefeld. Others in the billing department, including her boss, lacked the training needed to perform her essential duties. Her temporary departure caused problem after problem for the billing department.

No one, aside from Seefeld, knew passwords needed to access important insurance information used to put together bills for EMS calls. This led to a months-long delay in applying discounts to charges which need to be completed before an insurance company will pay a medical bill.

Traditionally, Seefeld would collect debts that went unpaid despite several reminders and put them in a packet for the ambulance commission, a public body with oversight of BDAS, to approve sending to collections. Wisconsin's Department of Revenue then usually rounded up the delinquent payments via withholding tax refunds.

While Seefeld was overseas, the audit found BDAS had no standard practice for picking charges to send for collections approval. However, the commission still received lists of past due accounts. When Seefeld and others asked how bills were chosen for collections consideration they were told not to worry because Amos Vande Hei, supervisor of the billings department, "has a process."

Vande Hei told auditors Seefeld never walked him or anyone else through how to choose delinquent accounts before she deployed. He simply picked from a subset of bills that were over a year old.

Five months into Seefeld's absence, a billing department staff member approached Vande Hei and said she was having difficulty applying payments received to the correct outstanding bills. Vande Hei told the auditors he took over the task, but it wasn't until January (another two months later) that Vande Hei actually began adding any to the system. After February, he decided the department would wait until Seefeld returned that summer before entering many more payments.

The report called timely remittance data entry "crucial" because commission reports, revenue records and financial statements relied on it.

The audit noted that Vande Hei's billing department lacked oversight by anyone with "adequate knowledge of accounting or finance principals." An organizational chart contained in the audit shows Vande Hei reported to Deputy Chief John Rago and the entire EMS service fell under Chief Dana Sechler.

Vande Hei offered no comment to 27 News other than to say he believed the audit would be corrected at an upcoming ambulance commission meeting but did not elaborate on what those corrections would be.

In its recommendations of changes, the report advised that the BDAS billing department should divide jobs among the staff and create overlaps in responsibilities. Multiple people sharing duties, it argued, would prevent one person from having sole access to records and money. It would also ensure more than one person is trained to perform every task the department undertakes.

However, the report goes on to point out that the billing department's staff is limited (with most of its members working part-time) and may not have the number of people necessary to ensure proper workloads. For this reason, the audit recommends, as the first of three possible solutions, to outsource the billing department entirely. Doing so, the auditors write, would lead to the EMS service getting "independent and reliable financial reporting."

Another option proposed in the report is to restructure the billing department to create a division devoted to accounting and another to billing and collections. Currently, some staff split their time between the two and do not master either, according to the report.

The third choice laid out by the audit would be to move the BDAS billing responsibilities and staff under the umbrella of the city of Baraboo's Finance Department. This "should allow for proper oversight of the District's accounting functions and obtaining reliable financial reporting," the auditors wrote.

Underfunded

The audit notes that as a result of its cash shortfalls BDAS needed to take out a line of credit to "meet its obligations."

Neither the report nor the ambulance commission's incomplete online postings of meeting minutes explicitly lay out how much was borrowed. But, at a July 24, 2019 session, commissioners discussed a possible $500,000 line of credit with Baraboo State Bank.

In September the commission approved charging member communities $30 for each person living its boundaries. City Attorney Emily Truman said Baraboo, by far the largest member municipality, previously paid $24 per capita. The higher amount represents a 25 percent increase from the year prior and the largest surge since at least 2010, according to city records.

The U.S. Census Bureau estimated Baraboo's population in 2018 (the most recent year with available data) to be 12,142. BDAS in effect asked the city for somewhere in the neighboorhood of $73,000 more than it had before. In total, the district wanted about $364,260 from its largest contributor.

The bigger ask came after ambulance commission meetings where members discussed replacing a phone system and preparations to build a new EMS building. The BDAS budget also has two new items listed under expenses: "Line of Credit" and "Interest Expense - Line of Credit." The pair total $77,000 and are likely to address potential debt service payments.

As part of its budget discussions, Truman said the Baraboo city council approved collecting the money needed to pay the $30 per capita charge, however, it only consented to give $27 for each of its residents. The extra $3 was to be held in reserve, as a sort of green-backed hostage, until the city could finance and complete an audit of the Baraboo District Ambulance Service.

The results are now in.

The ambulance commission is scheduled to review the report tonight at a 7 p.m. meeting. The Baraboo city council will do the same on Tuesday, Jan. 7.

JT Cestkowski

Social Media Content Producer/Desk Editor

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