Fire Rescue Fees(9 MIA.MIBEACH
BUDGET Al'lD PERFORMANCE IMPROVEMENT
l11ternal Audit Division
TO: Jorge M. Gonzalez, City Manager
INTERNAL AUDIT REPORT
VIA:
FROM:
Kathie G. Brooks, Budget and ~re~ance Improvement Director
James J. sutter, Internal Auditr/~
DATE: February 23, 2009
AUDIT: Fire Rescue Fees Audit
PERIOD: October 1, 2006-April 30, 2008
This rep~ort is the result of a regularly scheduled audit of the fire rescue fees billed by Advanced
Data Processing, Inc. or ADPI and collected at the City's Sun Trust Lockbox account.
INTRODUCTION
The Miami Beach Fire Department mission statement states "We are dedicated to provide our
community with a high level of safety and security through prevention of fire, delivery of quality
emergency and disaster services, ocean life guarding and fire and life safety educational programs."
To assist in the satisfaction of this statement, four strategically located fire stations are maintained
which house six Emergency Medical Service or EMS rescue units and an EMS Supervisor. All fire
units are advanced life support certified and staffed with paramedic personnel and can provide rapid
response to anywhere in the City.
Among other duties, the City's Fire Rescue Division established in October 1 966 responds to all
emergency medical incidents and provides pre-hospital care to the sick and injured. They transport
needy patients to area hospitals where they are released to emergency room staff.
The City Commission passed Resolution No. 2003-25302 authorizing the charging of $330 for Basic
Life Support, $380 for Advanced Life Support 1 and $490 for the most serious cases called
Advanced Life Support 2 to help recover costs. Additional charges in varying amounts are based on
the miles driven to the hospital and the need for rendering such other supplemental services as
cardiac monitoring, intravenous/intraosseous therapy, intubation, oxygen and spinal immobilization.
Despite these associated costs for transported patients, no needy individuals are deprived of Fire
Rescue transport services due to their inability to pay.
Advanced Data Processing, Inc. or AD PI originated in 197 4 and is currently the largest independent
provider of medical billing and coding services to emergency medical services agencies in the
United States according to the company's Internet website. They also provide a full outsourced
billing solution including the provision of mobile electronic patient record collection systems for its
clients to capture patient information at the scene of the incident. AD PI pmsently has more than
270 employees and serves 234 clients in twenty-two states and Washington D.C. Their corporate
office that contracts with Miami Beach is located at 500 NW 165111 Street in Miami, FL.
City Commission Memorandum No. 359-94 originally awarded ADPI a one year contract on May 18,
1994 to provide emergency medical transport billing and collection services with an option for two
additional years at the City Manager's discretion. A second agmementwas approved on December
15, 1999 and expired on December '15, 2004 after the City elected to renew the agreement for the
two additional one year terms. This agreement was further extended on a month to month basis
until June 2008 when a third consecutive agreement with ADPI was finalized. The agreement was
Internal Audit Report
Fire Rescue Fee Audit
February 23, 2009
signed by the City Clerk, City Manager and the vendor as it piggy backed off the Miami-Dade County
contract and did not need to be approved by the City Commission per City Code Section 2-369.
The City's Fire Rescue Division is frequently summoned when people are injured on Miami Beach
through the Public Safety Communications Unit when they call 9-1-1. Paramedics arrive and assess
the severity of the patient's injuries. No charges are levied unless the patient needs to be
transported by Fire Rescue to the hospital for further medical assistance.
Private transports may occur when the patient's injuries are not believed to be serious and they want
to be transported to a hospital not on Miami Beach. Another example of when a private transport is
called is when the fire truck is the initial responder and they call Fire Rescue for medical help but all
their units are busy. In either case, the private transport is responsible for billing and collecting from
the patient, independent of the City.
When this occurs, one of the firefighters is typically responsible for collecting and recording the
billing data from either the patient or any other accompanying individuals present. However, the
firefighters' main responsibility is to help injured people and not to pursue the collection of billing
information. They cannot refuse to help someone because they don't have the ability to pay. AD PI
is frequently assigned the task after the incident to obtain any needed missing information that could
not be obtained by Fire Rescue through contacting the hospital, researching databases, etc.
Previously, the Fire Rescue Division recorded all information in a handwritten paper based rescue
report whenever units replied to an emergency. This report included checklists and a narrative
section for the responding Rescue Team Leader to handwrite their observations and conclusions.
However, the paper based rescue reports did not allow for the efficient retrieval of data, resulting in
limitations in the department's ability to measure organizational and operational performance, as
well as effectively track outcomes and success rates of procedures.
Consequently, the City Commission passed Resolution No. 2006-26291 authorizing a purchase of
$100,900 of Rescuenet TabletPCR Software from Zoll Data Systems, Inc. The intent of this
purchase was to benefit the overall community as it enabled more time to be spent responding to
emergencies and treating patients, and less time writing and revising handwritten reports.
Fire Rescue sends an extract once a week of all transport billing information to ADPI where it is
received and transferred into their database. ADPI subsequently reviews the transmitted data and
ensures that the billing rates are proper and correct per City Resolution No. 2003-25302.
Invoices are prepared and mailed usually within fourteen days of receipt of the information by ADP I
to Medicaid, Medicare, insurance carriers or the individual. Any monies paid are collected directly by
the City at their SunTrust lockbox account. Both the City and ADPI receive a report listing the
amount of collected monies each day.
Form letters are mailed to delinquent customers after thirty to forty days with several more to follow if
the outstanding balance is not paid. No other collections efforts are made (factoring delinquent
accounts, hiring a collection agency, placing liens on property, etc.) per the City Commission's
direction.
The following table lists the relevant fire rescue data regarding calls and transports for the 2006/07
and 2007/08 fiscal years as compiled by the Fire Department's CAD and RMS and Rescue Net
databases:
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Fire Rescue Fee Audit
February 23, 2009
Rescue Calls
Total Transport
City Transport
Private Transport
FY 2006/07
16,488
8,244
6,760
1,484
FY 2007/08
15,160
7,580
6,513
1,067
AD PI prepares an invoice at the end of each month of the corresponding collections received by the
City's Sun Trust lockbox less their agreed upon fees. A supporting spreadsheet is also submitted
that shows how the numbers were calculated. These two documents are mailed to the Fire Rescue
Division Captain for approval before they are forwarded to the City's Finance Department for
processing and payment.
The City collected the following revenues less ADPI's fees during the audit period:
*
10/01/06-09/30/07 10/01/07-09/30/08 * Total
Revenues Collected $1,574,375 $1,173,900 $2,748,275
Less ADPI Fees ($121 ,053) ($95,060) ($216,113)
Total Net Fees $1,453,322 $1,078,840 $2,532,162
The figures as of the end of the audit period or 10/01/07-04/30/08 equaled revenues collected of $71 0,916;
less ADPI fees of $57,493 and total net fees of $653,423.
There is typically a time lag between when Fire Rescue transports the patient to when it receives the
corresponding payment from the insurance carriers (Blue Cross Blue Shield, Humana, etc.),
Medicare, Medicare, etc. These primary payers will typically pay their associated billed amounts
(less any patient deductibles or disputed amounts) between six and eighteen months.
OVERALL OPINION
Although inherent collection difficulties exist due to individuals' inability to pay or
unavailable/incomplete patient information, the reviewed City collections were slightly less than the
desired 60% rate for a variety of reasons. The 60% gross collection rate was a requirement of the
1994 agreement between AD PI and the City, and has continued to serve as the goal for collections
per ADPI. The City should consider revisiting collection process to determine whether changes are
warranted to help improve collection rates and total revenues.
The contractor was found to be essentially in compliance with the terms tested in the agreement.
Requested information was made readily accessible, complete and provided in an organized
manner allowing the City's performance to be more easily benchmarked and graded. Customers
were billed at the correct rates based on the Fire Rescue Division's description of services provided
and unpaid accounts received additional collection letters. Finally, the Finance Department properly
reconciled the monies deposited into the lockbox with various AD PI reports and correctly inputted all
received fire rescue fee amounts into the City's Financial System.
Despite all these positives, the following shortcomings were noted during our audit and are in need
of corrective action:
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Fire Rescue Fee Audit
February 23, 2009
• The contractor provided an aging report showing that the City has accumulated $12,056,158
in outstanding billings since being awarded the contract in 1994. Although some payments
may still be forthcoming, the contractor's 2006/07 collection rate of 56.42% is currently below
the desired 60% goal.
• The contractor's prior agreement with the City expired in December 2004 and was extended
on a month to month basis until June 2008 and it piggy backed off a municipal contract
which was not an approved practice. In addition, the new agreement did not address AD PI's
monthly $580 charge for mailing the required notice of privacy practices letters to all initial
customers.
• Miami Beach's fire rescue fees were set well below the average and median of twenty-seven
tested local municipalities, counties and agencies for all billable items except oxygen. New
rates were approved subsequent to our audit to bring the rates up to a more desirable level
to offset operating costs.
• The City's Fire Rescue Division underperformed according to ADPI's April 2008 prepared
Critical Statistics Report in providing the contractor with desired patient information to
expedite collection efforts. Noted contributing factors include firefighters/paramedics not
being required to list home and business phone numbers, inherent difficulties in obtaining
social security numbers and possibly not all recorded data being transmitted to ADPI.
• Although some reconciliations and approvals are done, no department is reconciling the
amounts received in the City's lockbox with AD PI's invoices or ensuring that all transported
patients are actually billed.
• Individuals currently can only pay their outstanding fire rescue fee balances by check or
money order as debit and credit cards and on-line payments are not accepted.
• The City's September 2007 contractor payment for $9,840.02 was not accrued in the
2006/07 fiscal year.
• The City did not pay the contractor timely within thirty days of receipt and acceptance of
ADPI's invoice in 47.37% (9/19) of the months tested.
PURPOSE
The purpose of this audit is to determine whether the contractor complied with selected terms in
their signed agreement, whether the City's Fire Rescue Division provided complete accurate patient
transport information that was fully extracted by the contractor, and whether the Finance Department
correctly recorded all SunTrust lockbox payments and timely paid all corresponding received
invoices.
SCOPE
1. Confirm that the City is providing the contractor with the names, addresses and
amounts for billing for each person transported by a rescue vehicle, and that these
documents are being furnished to the contractor within one week, and that billing is
initiated within five days upon receipt of these documents.
2. Confirm that the City's Fire Rescue Division and Finance Department are reconciling
the number of billings provided to the contractor with the number actually billed and
is comparing the amounts received at the lockbox with those on the contractor's
monthly invoices.
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February 23, 2009
3. Confirm that the contractor is taking timely and appropriate follow-up action on
delinquencies and is mailing additional invoices to collect amount due.
4. Confirm that the contractor is adhering to the lockbox agreement and all collections
for services billed are deposited into the approved SunTrust lockbox.
5. Confirm that the contractor has properly calculated and the City timely paid the
invoiced monthly collection fees.
6. Confirm that daily collections were accurately recorded in the City's Financial
System.
FINDINGS, RECOMMENDATIONS AND MANAGEMENT RESPONSES
1. Finding-Uncollectible Billings
ADPI has been continuously retained by the City since 1994 for rescue ambulance billing
and related professional services. An aging report provided by ADPI showing the City's
uncollected fire rescue fee balances as of 05/23/08 is summarized in Exhibit B. A large
portion of this balance, $9,727,462 out of $12,056,158 (80.6%), represents uncollected
balances prior to FY 2006/07 and is highly unlikely to be collected. AD PI management said
that they have not been instructed by the City to write off any unpaid accounts as
uncollectible so this report is all inclusive.
Most likely, a portion of the listed $2,328,696 in FY2006/07 and FY2007/08 balances will be
collected as insurance carriers can take in excess of 180 days to pay outstanding amounts.
This fact will also help increase ADPI's fiscal year 2006/07 gross collection rate from its
current amount of 56.42%, which is below the desired 60% threshold set as a goal for Miami
Beach. The 60% gross collection rate was a requirement of ADPI's initial1994 contract with
the City and as remained as a goal per inquiries with the contractor. However, it was not
listed in the agreement in effect during the audit period or in the one most recently signed in
June 2008.
Recommendation( s)
The City should determine whether to have ADPI write off designated City accounts as
uncollectible so that the carried balance is more reflective of the actual. Going forward, the
feasibility of hiring a collection agency along with writing off delinquent accounts receivable
after a specified period of time should be discussed. The City should also work closely with
ADPI in an effort to help increase the gross collection rate.
Management's Response
City staff from the Fire and Finance Departments have met with staff from Advanced Data
Processing, Inc. (ADPI). ADPI, has agreed to begin accepting credit card and debit card
payments on our behalf, in addition to the other current payment methods already accepted.
This action should favorably impact our receivables, as those customers who do not have
the cash readily available, may chose to charge their medical expenses on a charge card.
ADPI, the largest independent provider of medical billing and coding services to the industry,
has also informed the City that they have merged EPBS-Intermedix, creating an even more
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February 23, 2009
extensive comprehensive billing, consulting, and practice management firm. EPBS-
Intermedix maintains its own proprietary billing and claims management software and is
a leading submitter of electronic insurance claims. This merger will assist the City's Fire
Department in recuperating many of the uncollected accounts. Of those amounts deemed
uncollectible, ADPI and Fire Department staff will inform the Finance Department which
amounts should be written off.
The Fire Rescue Division has recently been able to recover approximately $240,000 in 2008
from Medicaid by working closely with Mt. Sinai Hospital. These monies were received when
the hospital signed a form attesting to receiving patients transported directly by Fire Rescue
personnel.
2. Finding -Expired Agreement
The City's agreement with Advanced Data Processing, Inc. (ADPI) dated December 15,
1999 expired in December 15, 2004 but was extended on a month-to-month basis until June
17, 2008 when a new agreement was finalized and signed by the contractor, City Manager
and City Clerk. The agreement did not need to be approved by the City Commission as it
piggy backed off the Miami-Dade County contract per City Code Section 2-369.
This prior agreement that initially expired on December 15, 2004 piggy backed off ADPI's
contract with Boca Raton, FL which was not an acceptable practice as the City only has the
ability to piggy back off State of Florida, Miami-Dade County, School Board and General
Services Administration contracts. While this agreement was entered into before the
existing Procurement Director was hired, since then the Procurement Office has been
diligent in only allowing new agreements to piggy back from the proper agencies.
Among other terms, the new agreement reduces the City's payout to the contractor from
7.0% to 6.5% of all fire rescue fee monies collected excluding Medicaid accounts, as well as
decreases the Medicaid account transaction processing fee from $11.40 to $10.00. These
lower negotiated fees will help allow the City to increase its revenue intake per transport
thereby assisting in offsetting operating costs of the Fire Rescue Division.
However the new agreement did not address ADPI's $580 monthly charge for mailing the
Health Insurance Portability and Accountability Act's (HIPAA) required notice of privacy
practices letters to all initial customers. This two page form letter informs the reader about
how medical information about you may be used and disclosed and how you can get access
to this information. This arrangement which originated in 2003 was also not mentioned in
the contractor's previous agreement but the City has been paying the monthly charge ever
since. Efforts to locate documentation whereby the City authorized AD PI to mail these form
letters on their behalf at a fixed monthly rate of $580 could not be found but the Fire Rescue
Division has allowed it to exist and continue.
Another noted shortcoming of both the new and previous agreements is ADPI's requirement
to file claims and send invoices to all self-pay patient/payers within five days of receipt of
incident information. Inquiries revealed that ADPI's internal operating goal is to mail the
invoice within fourteen days of receipt of complete incident information which is inconsistent
with the stated contract goal. ADPI is meeting their internal operating goal of 14 days.
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Recommendation( s)
The new agreement should be amended to include the $580 monthly charge for mailing the
HIPAA mandated privacy notice statements and the City should opine and document
whether fourteen days to mail the self-payers' invoice is acceptable.
Management's Response
No further contracts are being pigged-back off of other municipalities but only to those
applicable agencies, State of Florida, Miami-Dade County, School Board and General
Services Administration.
The inclusion of the $580.00 for issuance of HIPPA notices needs to be inserted into the
current contract. The cost has remained constant since the original contract was executed
and has been cost effective when printing, postage, and clerical costs are considered.
3. Finding -Fee Analysis Results
During the audit period Miami Beach's Fire Rescue Transport fees were well below the
average and median for all listed transport services except oxygen of the fire rescue fees
charged by twenty-seven selected cities, counties and agencies in South Florida (see Exhibit
A). On September 17, 2008, the City Commission adopted a resolution to raise the Fire
Rescue transport fees subject to approval by the Miami-Dade County. The new fees
structure will place our fees above the median charged by other agencies and allow the City
to better offset the operating costs of the rescue Division.
Furthermore, ADPI estimates that its average collection rate for individuals across all their
clients is approximately 5 to 8% as compared to a very high percentage (over 90%) from
primary payment sources (insurance carriers, Medicare and Medicaid) where all the patient's
information is known. Therefore, they have been recommending that their clients set their
fire rescue fees high to collect the most from the primary payment sources (insurance
carriers, Medicare and Medicaid). Further, they recommend that payments from individuals
no longer be pursued as aggressively. They contend that the end result would be to
increase revenues for the City as well as reduce collection costs.
For example, Medicare will pay either $550 for Advanced Life Support 2 orALS 2 or the
City's transport costs ($490), whichever is less. Therefore, the City is currently not collecting
$60 per ALS 2 performed on Medicare patients as they typically pay 1 00% of all claims
submitted.
Recommendation( s)
The City should aggressively pursue approval from the County of the rates recently
approved by the Commission and above the designated Medicare threshold. Also, the City
should evaluate the merits of ADPI's fee setting recommendations to determine its
worthiness.
Management's Response
The increase request can only be placed on the County Commission agenda by request of a
County Commissioner. The City's Economic Development Director has been in contact with
the Chief's of Staff of two County Commissioners and is awaiting a response from one of
those Commissioners as to their willingness to sponsor the item.
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4. Finding -Incomplete Documentation
The City's Fire Rescue Division is responsible for obtaining the patient's pertinent
information (name, social security number, address, home phone, etc.) and forwarding it to
ADPI for billing and collection purposes. When provided information is either incorrect or
missing, the overall process may be adversely affected and ADPI must try to obtain this
information through other means.
ADPI estimated that the patient's insurance information is m1ssmg 90% of the time.
However, the Fire Division Chief stated that they typically don't request this information as
their primary focus is on obtaining the patient's social security number. Which in some
cases is hindered by the number of foreign tourists, homeless and incoherent patients
treated in Miami Beach.
Using collected social security data, the Fire Division Chief claims that AD PI should be able
to collect any other needed information. Among other options, AD PI can collect any needed
patient information by contacting the hospital upon admittance or by accessing lntermedix's
(a company recently acquired by ADPI that helps engineer advanced technologies into
business processes to meet incident documentation requirements, realize revenue potential,
and provide advanced informatics to clients per the company's website) resources. The fire
fighters' objective is on treating the patient and not collecting billing information.
Concerns were also raised that patient information is not being completely transmitted to
ADPI during submission of their extracts. As a result, the Fire Rescue Division has
upgraded their RescueNet tablet PCR Software to version 5.02 in October 2008 to help
alleviate any potential transmission problems. The Fire Rescue Division Chief said that he is
not aware of any transmission problems involving the new software.
Finally, ADPI stated that they periodically offer "train the trainer" classes at no charge to
review completion of the needed patient information to facilitate billing and collection but the
Fire Rescue Division has not participated as of yet.
Recommendation( s)
The Fire Rescue Division should collect as much billing information as possible to facilitate
collection without interfering with their primary goal of assisting the patient. In addition, the
Fire Rescue Division should perform an analysis to help ensure that all transmitted patient
extract information is being received by ADPI. Finally, the Fire Rescue Division should
designate employees to attend the provided training classes in an effort to help improve the
City's ranking and collections.
Management's Response
The current upgraded software version now matches that of the City of Hialeah, another
AD PI client who has been sending billing extracts successfully. Our extract configuration will
be set to match that of Hialeah's.
Train the trainer classes were provided to two members of the Fire Department Staff in
November. All EMS personnel recently attended classes to enhance their knowledge of
billing requirements on December 16111 , 1 i'\ and 18 111 •
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5. Finding -Reconciliations
The Finance Department properly reconciles the City's SunTrust lockbox account with
ADPI's Cash Log Report. Similarly, the Fire Rescue Division attests to the mathematical
accuracy of the contractor's invoice submitted at a later date. However, neither department
compares the amounts collected in the lockbox with those listed on ADPI's invoices to
ensure that the City was properly billed. Internal Audit's subsequent review found several
minor differences during the audit period.
In addition, the Fire Rescue Division does not reconcile ADPI's number of billings with the
number of transport services actually provided. Consequently, it cannot be confirmed that all
provided emergency transports were actually billed, especially given the aforementioned
difficulties with the transmission of patient extracts discussed in finding 4.
Recommendation( s)
The Finance Department should reconcile ADPI's monthly invoices with the supporting
documentation and immediately investigate any found differences. The designated reviewer
should initial the invoices attesting to their approval and authorizing payment in full. Also,
the Fire Rescue Division Chief or designee should reconcile monthly the number of transport
services provided by his firefighters/paramedics with the number billed by ADPI to confirm
that all were received and billed by the contractor.
Management's Response
The Fire Department will provide to the Finance Department, ADPI's monthly invoices with
supporting documentation in order to reconcile any discrepancies. The Fire Department will
reconcile the number of transport services provided by firefighter/paramedics with the
number billed by AD PI to confirm that all transports are billed. Fire Department staff has met
with Mt. Sinai staff, where over nine out of every ten transports are taken to, in order to
streamline and expedite the flow of paperwork and add additional checks and balances.
6. Finding -Payment Options
All fire rescue fee payments made by check or money order are received directly at the City's
SunTrust lockbox account which processes payments faster while reducing float and
reconcilement costs. However, Internal Audit believes that more individuals may pay if the
City also accepted debit and credit cards. Inquiries revealed that debit and credit card
payments for fire rescue fees could be processed by either an outside company like Moneris
or through the City's Central Cashier's Office.
Recommendation( s)
The Fire Rescue Division, Finance Department, Sun Trust and AD PI should work together to
determine an efficient process by which individuals can pay their fire rescue fee balances
with debit and credit cards. The option to make online payments should be explored.
Management's Response
City staff from the Fire and Finance Departments have met with staff from Advanced Data
Processing, Inc. (ADPI). ADPI has agreed to begin accepting credit card and debit card
payments on our behalf, in addition to the other current payment methods already accepted.
This action should favorably impact our receivables, as those customers who do not have
the cash readily available, may chose to charge their medical expenses on a charge card.
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7. Finding-Incorrect General Ledger Entry
The City's 10/31/2007 payment of $9,840.02 to ADPI for claims processed in September
2007 was included in the 2007/08 fiscal year under general ledger account "Ambulance
Fees -Lock Box ADP" (011-8000-342655). This expense should have been accrued in
fiscal year 2006/07.
Recommendation( s)
Expenses should be accrued in the year that the item was incurred. Greater care should be
made by the department to follow up on any final unpaid invoices for year-end and timely
forwarding them to Finance for payment. General ledger account transactions and balances
should be reviewed prior to year end to help identify any missing payments.
Management's Response
At this time, departments were entering their own invoices and were responsible for advising
Accounts Payable of prior year expenses so that the appropriate accrual could be booked.
8. Finding -Late Contractor Payments
Section 4 of the ADPI agreement states "The City shall issue a check for the amount
invoiced, minus any disputed amount, within thirty (30) days of receipt and acceptance of the
invoice." Yet, testing showed that the City issued check was prepared late or past the due
date for seven of the audit period's nineteen months or 36.84% with the maximum number of
days late being fourteen .. An analysis of Finance's source documentation and the approval
queues in the Eden System indicate that the delays were attributed to the Fire Department
Recommendation( s)
The Fire Departments should make more of a concerted effort to process the invoices for
payment in a timelier manner.
Management's Response
Much of the delay can be attributed to Fire Rescue Division's move to 1680 Meridian Avenue
from 2300 Pine Tree Drive and not receiving the invoices timely. Several had to be re-sent
by ADPI and the invoice dates were not changed to note this fact.
9. Finding-Insurance Coverage
Section 9 of the ADPI agreement details the required insurance coverage that should be
maintained by the contractor. Testing showed that ADPI complied with all provisions except
to have the City named as an additional insured where applicable. Upon notification, the
necessary changes were made and the new policy was presented to and approved by the
City's Risk Manager.
Recommendation(s)
ADPI's insurance coverage should satisfy the terms listed in the signed agreement at all
times.
Management's Response
The Chief of EMS will request a copy of the proof of insurance each year and forward to
Risk Management to be filed.
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Fire Rescue Fee Audit
February 23, 2009
EXIT CONFERENCE
An exit conference was held on December 9, 2008 in OBPI's conference room. Participants
included Fire Division Chief Javier Otero, Fire Division Chief Chris Parrino, Assistant Finance
Director Georgina Echert, Revenue Manager Manuel Marquez Jr., Internal Auditor James Sutter and
Senior Auditor Mark Coolidge. All parties were in agreement as to the contents of this report.
Management responses were solicited and included in our report.
JJS:MC:mc
(Audit performed by Mark Coolidge, Senior Auditor)
F:\obpi\$AUD\INTERNAL AUDIT FILES\DOC0?-08\REPORTS-DRAFT\FIRE RESCUE FEES.doc
Exhibits
cc: Eric Yuhr, Fire Chief
Patricia Walker, Chief Financial Officer
Gus Lopez, Procurement Division Director
Darryl Hartung, Regional Director, ADPI
Page 11 of 14
Exhibit A
Fire Rescue Fee Analysis for Local Cities/Counties/Agencies
Listed fees are as of June 6, 2008
*
**
Advanced Advanced Specialty Supplemental Care Basic Life Cities/Counties Life Life Transports Support Oxygen Per Mile Items
Support 1 Support 2 ** *
Pompano Beach $ 750.00 $ 750.00 $ 750.00 $50.00 $ 10.00
Deerfield Beach $ 700.00 $ 750.00 $ 650.00 $ 12.00
Margate $ 700.00 $ 750.00 $ 700.00 $ 10.00
Miramar $ 700.00 $ 750.00 $ 700.00 $ 10.00
Miami Beach
(Commission
Recommended Rates as
of 1 0/1/08) $ 630.00 $ 500.00 $ 430.00 $30.00 $ 7.50 Yes
Boca Raton $ 554.44 $ 715.42 $ 745.22 $ 554.44 $ 10.15
Hallandale Beach $ 500.00 $ 500.00 $ 500.00 $20.00 $ 7.50
Lighthouse Point $ 500.00 $ 600.00 $ 500.00 $ 9.00
Monroe $ 500.00 $ 600.00 $ 500.00 $ 9.00
Lauderhill $ 475.00 $ 575.00 $ 450.00 $ 9.00
Palm Beach County $ 470.00 $ 630.00 $ 470.00 $ 8.50
Broward Sheriff $ 460.00 $ 575.00 $ 450.00 $27.00 $ 8.00 Yes
Cooper City $ 460.00 $ 575.00 $ 450.00 $27.00 $ 8.00
Fort Lauderdale $ 452.00 $ 525.00 $ 425.00 $30.30 $ 8.50
Coral Springs $ 450.00 $ 575.00 $ 400.00 $ 7.00 Yes
Dania Beach $ 450.00 $ 550.00 $ 450.00 $ 9.00
Hollywood $ 450.00 $ 550.00 $ 450.00 $ 9.00
North Lauderdale $ 450.00 $ 550.00 $ 425.00 $ 8.00
Riviera Beach $ 450.00 $ 575.00 $ 450.00 $ 8.00 Yes
Davie $ 400.00 $ 530.00 $ 400.00 $30.00 $ 8.00 Yes
Tamarac $ 400.00 $ 500.00 $ 360.00 $ 7.25 Yes
Miami*** $ 390.00 $ 550.00 $ 650.00 $ 330.00 $ 7.50 Yes
Key Biscayne $ 390.00 $ 550.00 $ 650.00 $ 330.00 $ 7.50 Yes
Miami Dade $ 380.00 $ 490.00 $ 330.00 $30.00 $ 7.50 Yes
Miami Beach (Current
Rates) $ 380.00 $ 490.00 $ 330.00 $30.00 $ 7.50 Yes
Hialeah $ 380.00 $ 490.00 $ 330.00 $30.00 $ 7.50 Yes
Plantation $ 360.00 $ 480.00 $ 330.00 $ 25.00 $ 7.00 Yes
Coral Gables**** $ 310.00 $ 310.00 $ 310.00 $30.00 $ 7.50 Yes
Average $ 490.48 $ 586.48 $ 745.22 $ 473.10 $29.93 $ 8.56
Median $ 456.00 $ 575.00 $ 745.22 $ 450.00 $ 30.00 $ 8.25
Specialty Care Transports occur when a nurse or doctor accompany a patient as they are being transported
from one hospital to another for treatment.
Supplemental items and fees vary greatly per entity and include cardiac monitoring, intravenous and
intraosseous therapy, intubation, spinal immobilization, backboard, cervical collar, etc.
Page 12 of 14
Internal Audit Report
Fire Rescue Fee Audit
February 23, 2009
The listed fees for the City of Miami are much higher than those listed in their City Code Section 2-234. New
fee increases are currently being recommended to their City Commission for adoption.
Emergency fire rescue services are provided at no charge to Coral Gables residents as it is included in their
property taxes paid annually. The City Commission through City Code Sections 26-1 and 30-6 has assessed
nonresidents the listed rates.
Source: ADPI's Regional Director, Internet research and phone calls
Page 13 of 14
Internal Audit Report
Fire Rescue Fee Audit
February 23, 2009
Exhibit B
Fire Rescue Fees Accounts Receivable Aging Report for Miami Beach Transports
Listed balances are as of May 23, 2008
FISCAL
YEAR
94/95
95/96
96/97
97/98
98/99
99/00
00/01
01/02
02/03
03/04
04/05
05/06
Subtotal
06/07
07/08
Total
CURRENT
$0
0
0
0
0
0
0
0
0
0
0
0
$0
(31,932)
($31,932)
30
DAYS
$0
0
0
0
0
0
0
0
0
0
0
0
$0
187,825
$187,825
60
DAYS
$0
0
0
0
0
0
0
0
0
0
0
0
$0
193,652
$193,652
90 120
DAYS DAYS
$0 $0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
$0 $0
170,748 99,221
$170,748 $99,221
Page 14 of 14
PAST DUE
150 180 240
DAYS DAYS DAYS
$0 $0 $0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
$0
80,227
$0 $320,408
189,334 360,043
$80,227 $189,334 $680,451
360
DAYS
$485,254
545,689
609,599
577,817
609,924
850,409
1,127,684
876,234
1,059,362
1,130,401
865,637
989,452
$9,727,462
$759,171
0
$10,486,633
TOTAL
$485,254
545,689
609,599
577,817
609,924
850,409
1,127,684
876,234
1,059,362
1,130,401
865,637
989,452
$9,727,462
$1,079,579
1,249,118
$12,056,158