Dear Citizens of Avoyelles:
When I ran for and accepted the honor of serving as Sheriff for Avoyelles Parish I promised an honest administration. In keeping with that promise I want to provide the facts regarding the Acadian Ambulance contract I inherited from the former administration.
I have read the recent letter written by former Sheriff Belt regarding the history of the ambulance controversy. While I applaud Sheriff Belt for establishing essential, high quality ambulance services, Sheriff Belt’s recollection that “every dime owed to Acadian was paid” is simply not true. The contract Sheriff Belt signed did not provide for free ambulance service; rather, it required that the combination of dedicated tax revenues and in-kind services would be, as required by law, sufficient to cover co-pays and deductibles for all ambulance transports. Unfortunately, due to volume and the cost of ambulance transportation, by 2003 the Sheriff’s obligations under the contract were deeply in arrears.
On July 1, 2003, former Sheriff Belt entered into a settlement agreement with Acadian Ambulance Service acknowledging that from time to time since the March 1993 Ambulance Service Agreement various issues had arisen between the Law Enforcement District and Acadian Ambulance regarding amounts owed. As part of that settlement, the old Ambulance service contract was terminated and a new 10 year Agreement was entered into by then Sheriff Belt.
That new contract, in accordance with Federal and State laws, provided that Acadian would perform all transports on a fee for service basis, and all residents (or their insurers) would have a legal obligation to pay. Acadian was to bill all third party insurers and individuals that had the ability to pay. The Law Enforcement District was to pay a monthly fee to Acadian, using a portion of the collected tax revenue to cover indigent transports as well as the co-pays and deductibles which otherwise would be the responsibility of the patients having third party coverage. Thus, under the 2003 contract, despite the fact that all residents of the parish paid the tax, only those residents who had insurance, who were covered by Medicaid or Medicare, and/or who were determined to be indigent actually received ambulance service that was perceived as “free” by virtue of the payments made using the tax revenues. Under the contract executed by Sheriff Belt, those uninsured residents with the ability to pay had to pay all costs of the transport.
Initially, based on the number of transports in 2003, the amount determined necessary to be paid to Acadian for co-pays and deductibles was set at $90,000.00 a year or $7,500.00 per month. The $90,000.00 a year payment was subject to annual review and had to be renegotiated if the amount of the co-payments and deductibles and/or utilization increased by more than 10% in any year. The contract also stated that either party could renegotiate the contract if a change in the law made it necessary for compliance reasons.
I first became aware of the issues that had arisen since the 2003 contract in January 2009 during a visit I made to Acadian’s call center in Lafayette to get ideas for improvement of the Avoyelles Parish 911 call center. During that visit, Acadian presented me with a bill in the amount of $1,392,462.52 for Ambulance services provided to residents of Avoyelles between 2006 and 2008. Prior to that time, I had no knowledge of any dispute between Acadian and the Sheriff’s office as then Sheriff Belt never disclosed the issue during the transition from his to my administration. I returned to Marksville with the bill and contacted legal counsel to begin looking into the issues raised by the bill and the legitimacy of the claims of Acadian. When asked how long the dispute had existed, Acadian indicated that they had attempted to work out disagreements that had arisen with the prior administration before I took office in July 2008 but that the issue remained unresolved.
Upon inquiry, I learned that three issues led to Acadian’s presentation of the bill: It was Acadian’s belief (1) that the 2003 contract had been breached when then Sheriff Belt, on behalf of the Law Enforcement District, despite clear contractual provisions, refused to renegotiate the $90,000.00 payment for co-pays and deductibles despite a dramatic increase in the number of transports since the 2003 contract and a corresponding increase in the co-pays and deductibles; (2) that the contract had been breached on the grounds that the indigent investigations were not being done properly as then Sheriff Belt was declaring all uninsured residents of the Parish to be “indigents” unable to pay for the services; and (3) the contract had been breached on the grounds that the Federal Anti-Kickback Law mandate that Parish payments be equivalent to the co-payments due for the current volume of ambulance service. In support of their position, Acadian referred to a legal opinion provided to them that concluded the contract had to be renegotiated both on the basis of the change in payment needed to cover the co-pays and deductibles and to assure compliance with State and Federal laws.
For over a year and a half, my office and legal counsel studied the issues presented by Acadian and the terms of the contract. We challenged the sums Acadian claimed were due and even asserted defenses against the claims. We also looked at other options that we hoped would continue to provide what was perceived by the public as the “free” ambulance service even though under the 2003 agreement that service was no longer “free.” What did become apparent during this process was that regardless of how it happened, the Parish was upside down on its obligations under the ambulance service contract and that things would only get worse if the contract was not renegotiated.
Given the cost of operating and maintaining the 911 call center and the cost of continuing to provide the same level of service from the Sheriff’s office as had been provided in the past, there was simply not enough money left from the tax to allow the Law Enforcement District to continue making the payments necessary to Acadian to provide the “free” ambulance service and offset the required deductibles and co-pays in compliance with Federal Law. Accordingly, after negotiating the best available settlement terms possible, I sought and obtained governmental approval to settle Acadian’s claims. The terms of the settlement saved the Parish a substantial sum and also saved many residents from being billed for services Acadian had provided since the 2003 contract. I also obtained government approval to negotiate and enter into a new Ambulance service agreement that would not give rise to future payment problems or interruption of ambulance or 911 services for the residents of Avoyelles. This new agreement is essentially the same agreement Acadian has with every other Parish it serves.
We all know it's easy to tell people what they want to hear but it takes courage and integrity to tell the truth. It is my sincere hope that the above facts shed some light on some of the issues that arose as a result of the 2003 Ambulance Service Agreement and which ultimately led to my administration having to make difficult choices to ensure the continued availability of emergency services, both ambulance and 911 communications, to the residents of Avoyelles.
All citizens can continue to rely on my pledge to honestly and ethically continue my efforts to assure the safety and security of every resident and visitor to Avoyelles Parish.
Doug Anderson, Sheriff