Despite a city review’s criticism of EMSA for not using a competitive process in choosing contractors, the agency continues to sign contracts without seeking competing proposals, records show.
EMSA has signed contracts or continued to contract with at least four vendors since the city review began and has not requested proposals from competing companies, according to a report produced for the agency’s board meeting Wednesday.
Kelli Bruer, a spokeswoman for EMSA, said information on how much the vendors are being paid and when the contracts were signed was not available Wednesday. However, Bruer defended EMSA’s work in responding to the city review.
“The MRO (Management Review Office) review has been a good process and has been a tool to help us improve our operational efficiency,” she said. “We’ve made great progress in implementing the recommendations of the MRO and continue to follow or improve the policy and process recommendations, including the ones regarding purchasing and vendor contracts.”
The Emergency Medical Services Authority is a government agency that oversees a contractor that provides ambulance service to more than 1 million people in Tulsa, Oklahoma City and surrounding cities.
The city’s Management Review Office launched its review of EMSA in April following a Tulsa World investigation.
EMSA is also undergoing a state investigative audit into its billing procedures, travel spending, contracts and other issues raised by the World’s investigation. Patients seeking class-action status have sued the agency and its law firm in Tulsa County District Court, claiming that its billing procedures are deceptive.
The city review made about 50 findings related to EMSA’s practices and accompanying recommendations for improvement. Several key findings related to a lack of competitive bidding.
Out of nine providers that involved EMSA expenditures of $50,000 or more, “at least six and possibly more were sole source agreements,” the review states.
“EMSA’s CFO, Kent Torrence, indicates there has not, in the past, been consistent competitive bidding of services and commodities,” the review states.
EMSA’s purchasing policy excludes from competitive bidding “professional or other contractual services that are in their nature unique and/or not subject to competition.” The policy, updated in December, also does not require board approval of such contracts.
State laws generally exclude professional services from requirements to seek bids. However, many public agencies, including the city of Tulsa and Tulsa County, use a competitive process to request proposals from multiple providers for such services.
The matrix: During Wednesday’s meeting, EMSA provided a “matrix” updating its board members on the agency’s progress in responding to the city review. Many of the items on the matrix show that EMSA has either addressed the finding or has come up with a solution agreeable to the city.
However, six of the items on the matrix noted that due to lack of a competitive process, the city partially disagreed with EMSA’s response.
In response to the city review’s finding that EMSA should review its purchasing practices, EMSA states that it disagrees.
“With the recent changes in place, EMSA believes that policies are adequate,” the matrix states.
“MRO disagrees,” states a response by the city. “More competitive bidding would force EMSA to do a better job of specifying exactly what’s required and likely deliver a better value proposition.”
Phil Lakin, an EMSA trustee and Tulsa city councilor, requested the monthly report to track EMSA’s progress on responding to the city review.
“I think we just have to look ... closer into not only this ... but some of the other key findings, as well,” Lakin told the World after Wednesday’s meeting. “That’s why the matrix was so important to me, so that we can monitor our performance in addressing each one of the issues.”
Lakin said he is not familiar with the legal requirements authorities must follow regarding competitive bidding.
“I need to be informed by staff, and I need to inform myself so that I can verify that we are making progress on every one of these points,” he said.
Responses raise more concerns: The city review recommended that EMSA handle many of its financial records in digital instead of paper format.
In a response to the review, EMSA indicated that it had held two meetings with RMS LLC, an Oklahoma City company specializing in electronic health-care records. The EMSA response states that the agency would present information on the company to EMSA’s board during its September meeting.
Minutes show that CEO Steve Williamson told board members during that meeting: “EMSA is moving ahead with this process and expects a good return on its investment.”
The board did not vote on the contract, and no formal proposals were sought from competitors, records show.
The city review also found that EMSA conducted limited analysis of phone calls, including complaints. EMSA’s response to the review says it held a “kick-off meeting” in July with representatives of i-Sight, software that tracks complaints in the health-care field.
The response notes that “pricing and integration has been determined” and that the software would be in place by January. I-Sight is produced by Customer Expressions, a Canadian firm.
“MRO reserves judgment to see how the information is used,” states a city response to EMSA. “Again, (we have) concerns about the lack of a competitive procurement process to engage i-Sight.”
To address the city’s recommendation involving improving security over credit card information, EMSA signed a contract with True Digital Security Inc., a Tulsa company, records show.
“Good plan; uncertain whether a better fit could have been secured through a competitive process,” the city’s response to EMSA states.
EMSA has also not put its legal contract through a competitive process, as suggested by the city review. EMSA has contracted with a Tulsa law firm, Works and Lentz, since 1989.
Williamson negotiated the contract and amended it in 2006. Last year, EMSA hired the firm to handle claims from workers compensation cases.
Works & Lentz hired Williamson’s daughter as a file clerk when she was in high school. She worked part time for the firm while in college and was later hired to work full time in its Payroll Department. The relationship was not disclosed to EMSA’s board.
In its response to the city review, EMSA states that the agency is “open to recompeting the WL (Works & Lentz) contract, but that a substantial performance bond would be a requirement.”
Federal audits: In other business, the board voted to approve a repayment of $365,889 to the federal government following an audit into EMSA’s Medicare billings. That audit was conducted by the U.S. Department of Health and Human Services’ Office of Inspector General.
The audit covered EMSA’s Western District, in the Oklahoma City area. It reviewed Medicare billings by EMSA in 2010 and found that out of 100 cases selected, 10 patient transports were not medically necessary.
The audit report says EMSA was paid $7.4 million for transports under the Medicare program in 2010. Based on the sample results, EMSA improperly billed for 1,210 advanced life support emergency transports that year, the report says.
Williamson said EMSA will appeal the results of the audit. He said he thinks at least eight of the 10 transports will be found on appeal to be medically necessary.
Williamson said EMSA had a similar review of its Tulsa district in 2006.
“It was for more money than this, and we ended up paying them only $4,000,” he said.