National MedTrans Network, a Ronkonkoma, L.I.-based company that dispatches nonemergency ambulances to mostly elderly and disabled New Yorkers, has grown at a stunning pace—with revenue increasing 1,765% from 2012 to 2015, according to Crain's data. But the city's ambulance companies that answer its calls say National MedTrans owes them more than $2 million, some of it for trips that date as far back as early 2015.
"We're just these suckers on the other end waiting for the money," said Al Rapisarda, CEO of Midwood Ambulance and Lifeline Ambulance, both based in Brooklyn, who is still owed $40,000 for shuttling patients to and from medical facilities.
The overdue funds complicate an already tough economic reality for the city's mostly family-owned ambulance companies, many of which are small businesses that collectively employ some 4,000 people in the New York City area.
National MedTrans has been recognized for its rapid growth by business publications including Inc. and Crain's, which, in August 2016, ranked it at No. 15 among the 50 fastest-growing firms in the New York area, with revenue of $73.7 million in 2015. Once a small transportation company on Long Island, it has benefited from the expansion of Medicaid and the growth of managed health care plans, which tightly control spending. The ambulance operators get reimbursed less than $200 per nonemergency trip from Medicaid managed care plans, but each trip actually costs them about $260, according to an analysis by the Downstate Ambulance Association.
As the broker, National MedTrans handles transportation requests from the so-called Managed Long Term Care plans that tend to elderly and disabled Medicaid patients. National MedTrans acts as the go-between with the ambulance companies and takes a fee on each transaction. It's responsible for processing the invoices from the ambulance operators and submitting them to the managed care companies for payment.
Demand for National MedTrans' services has exploded as other states have moved to managed care. National MedTrans is already serving two plans in California, each with more than 200,000 members, and has inked a deal with a Chicago managed care plan that will start offering transportation benefits this year, company President Billy McKee, who is based in Salt Lake City, told Crain's in August.
But that growth has led to delays in paying vendors, according to a representative of the Downstate Ambulance Association who spoke to McKee on Nov. 9 about the overdue payments, which around that time amounted to about $3 million. In a memo from the representative to association members that was obtained by Crain's, the representative said McKee "acknowledged they are growing fast and their systems have not been able to keep up." The representative said McKee told the trade association that National MedTrans has "substantial moneys owed to them" from health plans and were hoping to resolve some of those accounts receivable within 30 days. McKee said he would produce a dollar amount National MedTrans believed it owed each of the ambulance providers by Nov. 15 and would work with each one to reconcile any differences. The association's representative suggested the companies follow up with National MedTrans after that date.
That reconciliation process, however, has not yet been completed, according to ambulance company owners. While some payments have been made to some of the ambulance companies since then, the outstanding balance was about $2.6 million as of Dec. 9, according to the ambulance association.
The ambulance association first reached out to Crain's in late November as members grew more frustrated with National MedTrans. McKee did not respond to requests for comment. CEO Andrew Winakor told Crain's in an email on Dec. 5: "It's our policy not to comment on contract-related matters with our provider network and/or our managed care agreements."
That same day, Winakor wrote an email to one ambulance company and, referring to Crain's, said "we will not be in a position to offer a settlement agreement if National MedTrans is being negatively portrayed by virtue of the Association's communications to them," according to a copy of that message.
National MedTrans' robust expansion may be interfering with its ability to manage its business, said Karen Taddeo, an attorney for the ambulance trade group. Taddeo said National MedTrans "has admitted to me and to representatives from the association that the backlog is overwhelming." In her view, she said, "they've spent so much time and energy on their growth and marketing and ramping up the business that they haven't processed claims."
Executives from three of the 12 ambulance companies who say they are owed money spoke to Crain's on Dec. 12 about their frustrations with the overdue payments. Hunter Ambulance, a family- owned business founded in 1982 in Bay Shore, L.I., serves the five boroughs and Long Island, and makes more than 100,000 transports a year. It's still waiting for payments of at least $200,000 from National MedTrans, as of Dec. 22. About $150,000 of that is at least 90 days overdue, said President Dan Leibowitz.
"We're promised payments, we're promised timelines," Leibowitz said. "They either haven't processed the claims or received the money [from the health plans]. We're not sure."
Bronx-based SeniorCare, which employs 1,000 people, is still awaiting payment from National MedTrans on about $460,000 in invoices, including bills for its ambulette services, according to Chief Executive Michael Vatch. About 60% of the outstanding balance is more than 180 days old, and 34% is greater than one year old, he told the association in a Dec. 22 email.
The state Department of Health, when contacted about the ambulance companies' claims, said: "National MedTrans has a contractual agreement to make appropriate and timely payments to ambulance providers. If National MedTrans is not meeting its contractual obligations, they should work directly with the Downstate Ambulance Association to resolve any payment issues."
A version of this article appears in the January 1, 2017, print issue of Crain's New York Business as "Ambulance owners owed millions".
"Ambulance owners say a Long Island dispatcher owes them millions" originally appeared in Crain's New York Business.