August 30, 2015
Comm. Pennamon questioned the auditor about EMS and why more details were not included in the FY14 audit. He seemed to be concerned about the increase in accounts receivable.
He should be concerned about a lot more than that….changes to Patient Care Reports, Medicare/Medicaid billings, payroll errors, violations of personnel policy, and violations of HIPPA regulations.
In March 2014, Debria Murphy was hired by Karen Degges to be the “EMS auditor”. Money wasn’t coming in to EMS as Ms. Degges expected; however, Debria Murphy was not an auditor and had never been an auditor. This was only a ploy to fire Kathy Skinner (an 11 year employee) and to hire Debria Murphy who had worked with James Gregory for 12 years in Putnam County.
In September 2013, Putnam County had to pay back $9617.04 to Medicaid/Medicare for EMS billing and documentation errors while Debria Murphy was the EMS billing clerk. Ms. Murphy resigned from Putnam County 1/24/14. She didn’t do well as the EMS billing clerk in Putnam County according to their audit:
- 74% of all the billing was over 150 days old which amounted to $1,487,477 and the total Receivables were $1,937,000.
- Contractual adjustments (insurance, Medicare and Medicaid) were not written off properly
- Cash collections were not applied to the outstanding balances, and
- Remitting to third-party payors was not done in a timely manner.
All these things have been brought to the attention of the Jasper County BOC previously—when Debria Murphy as “auditor” had Ms. Skinner fired by saying she wasn’t doing her job.
So where does Jasper County stand as of the FY14 audit? Let’s look at the comparisons:
- EMS Calls FY13 1,480 FY14 1,423
- Trucks in service 2 3
- Charges for service FY13 $798,000 FY14 $663,000
- EMS Receivables FY13 $67,827 FY14 $88,076
- Receivables as a % of charges 9.0% 13.3%
Figures obtained from Jasper County audit
During Ms. Skinner’s termination hearing, the citizens and BOC were all told more money would be coming in because Ms. Murphy knew how to bill “correctly”.
How does Ms. Murphy bill?
EMS personnel turn in PCR’s or Patient Care Reports to show what all was done by the EMS crew. There have been complaints that Ms. Murphy has asked EMT/Paramedics to change the PCR’s so she could bill differently. If this is happening, it is insurance fraud!
Ms. Murphy also told Mike Benton, and he repeated it during a finance presentation, that there was trouble “all over the state” with Medicare/Medicaid billing and that’s why income wasn’t coming in, but all that would be soon corrected. We cannot verify if this is true or just an excuse.
HIPPA Violations can result in heavy fines
“Auditor” Debria Murphy was not a county employee, and was not a real auditor, when she was allowed by the County Manager, Karen Degges, to go through personal medical files and even take them out of the office, violating HIPPA regulations. Where the EMS billing office is located since Ms. Murphy took over also violates HIPPA regulations because people can and do go in and out of that office. Ms. Skinner warned both Ms. Degges and Ms. Murphy about these violations to no avail.
Violation of personnel policy
Ms. Murphy holds 2 jobs with the county and gets paid overtime for anything over 40 hours. She works as an EMT and sets her own schedule. She also works as the billing clerk as part of the new finance department set up by Karen Degges. No other county employee is allowed to hold two jobs, and despite this being brought up to the BOC more than once, nothing has changed. (They didn’t listen to complaints about Sherry Braley either.)
Ms. Murphy is in charge of turning in EMS payroll information. In months past she made several errors on paychecks. To make sure no one found out, she told EMS personnel affected she would just write them a check out of her personal account for the difference. At least one EMT took her up on this offer. Another told her “no way” and even reported this to Comm. Trammell; however, nothing was done about it, and it took several pay periods before that EMT was paid for the time missed by Debria Murphy.
Cash and other collections need to be audited—by a real auditor—and so do the submissions to Medicare and Medicaid.
With 2 instances of theft of county monies already caught and employees arrested, the BOC needs to step up and take notice of what is going on in EMS. Collections are down, receivables are up, overtime is soaring, morale is down.
Comm. Pennamon is right; EMS needs to be audited in more detail and so does any other department with cash going in and out, such as Landfill and Recreation. Controls have been lax and despite complaints and facts being presented to the BOC, nothing is done to check, review, and set higher standards and controls.
Debria Murphy’s handling of her job should be under strong scrutiny—
- Higher receivables and lower collections means less money for the county
- HIPPA violations
- Violation of personnel policies
- Possible fraud if changes to PCR’s submitted by EMT’s are made
- Payroll errors being covered up
Here is a copy of the email (letter) written to the BOC in April 2014 by Kathy Skinner, outlining both possible HIPPA violations and billing fraud by Debria Murphy.
Commissioners, don’t say you didn’t know or had no way of knowing when things blow up. You have been told more than once and by more than just TWG. Do something—vote to have an immediate audit of EMS collection and billing procedures, and then expand it to all cash collection areas in the county.