CLINTON, Iowa – Attorneys in the city of Clinton’s legal malpractice case spent Monday morning scrutinizing the opinions of the emergency medical services billing and coding expert hired by attorney Michael Walker.
As the legal malpractice suit against Walker and his law firm Hopkins and Huebner entered its third week of trial, Pittsburgh-based expert JR Henry returned to the stand to talk more about what he identified as claims for emergency services from the city of Clinton that didn’t comply with Medicare.
Walker represented the city in a federal False Claims Act suit brought on by former firefighter Timothy Schultheis in 2008. Schultheis alleged the city knowingly submitted false claims to Medicare and Medicaid by using the advanced life support code rather than the basic life support code in order to receive higher reimbursements.
The city claims Walker failed to properly analyze the case and his alleged negligence led to the city settling for $4.5 million in 2010. The city wants $4.67 million to cover the cost of the settlement as well as attorney and expert fees.
Court was adjourned early Friday so Henry could compare two exhibits, one which was a spreadsheet of the 330 claims he reviewed as part of his work in the legal malpractice case and the other a 425-page document that was supposed to contain the documentation from the 60 of those claims he identified as non-Medicare compliant.
However, Henry testified that in his review of the documents over the weekend, he found three “issues” with the exhibits, one of which led him to reduce the number of non-Medicare compliant claims to 59 because of a duplicate entry on the spreadsheet.
Documentation for one non-compliant claim was not contained in the 425-page document while some documentation for a claim he did not review as non-compliant was, Henry testified were the other two issues.
Following his rundown of the issues in the documents, Henry and Walker’s attorney, Bob Waterman, reviewed one of the non-compliant claims that was from a patient who reported left ankle pain. The crew did not perform an ALS intervention on the patient, and Clinton County did not have an emergency medical dispatch protocol, but it was submitted as ALS. Further, the narrative on the patient care report stated the paramedics decided to “BLS” the patient, all of which led Henry to his conclusion that it was not compliant with Medicare.
“If there’s no ALS interventions performed, in my opinion, it should have been submitted at the BLS level,” Henry testified.