American Medical Response Evaluation Sheet Explanation
Comparative Selection Criteria
Management Experience: Highly Advantageous (3)
Location of Service: Highly Advantageous (3)
Participation in Emergency Planning: Highly Advantageous (3)
Legal Performance: Unacceptable (0)
 The RFP criterion lists any “administrative or judicial proceedings being filed against the
proposer or its principal officer(s) or agent(s) or employees, relating to operation of
proposer’s ambulance business…” within two years as “unacceptable”. In May of 2011,
American Medical Response agreed to settle an administrative action with the United
States Department of Health and Human Services’ Office of the Inspector General. The
settlement involved American Medical Response paying $2.7 Million to the United
States and signing a Corporate Integrity Agreement.
Required Information
Signed Cover Letter: Incomplete (1)
 American Medical Response failed to provide a signed cover letter which binds the
company to the statements within their RFP.
Qualifications and Experience: Incomplete (1)
 The RFP, in Section IV.D, requires vendors to include any information indicating if the
vendor’s “firm has been dismissed or disqualified or withdrawn from a bid/contract
within the past five years, and if yes, the reason(s) why”. American Medical Response
did not include any information in their bid package relating to any such events. In
December 2012, American Medical Response was terminated from their 911 contract by
the Town of Plymouth, Ma. This termination was made under Section 1 of the contract
between American Medical Response and the Town of Plymouth, which read, “Either
party may terminate this Agreement without cause by one hundred and twenty (120)
days written notice to the other party”. Additionally, in November of 2012, American
Medical Response withdrew from its contract with Newburyport, Salisbury and West
Newbury, Ma. This withdrawal was prompted, as stated by American Medical
Ambulance, after wage concession negotiations with the National Emergency Medical
Services Association union failed.
Minimum Qualification Criteria: Complete (2)
Acknowledgement of reimbursement: Complete (2)
Anticipated schedule of fees: Complete (2)
Listing of Insurance companies: Complete (2)
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American Medical Response Evaluation Sheet Explanation
Acknowledgement of addenda: Complete (2)
Non-collusion Statement: Complete (2)
A list of references: Complete (2)
Interviews – Vendor Presentations
Management Competency: Excellent (4)
Financial Support and Stability: Good (3)
 Vendor discussed the closing of the Newburyport operations as an economic move to cut
costs.
Customer Billing and Service: Good (3)
 In 2011 customer complaints over billing practices lead to a City audit of AMR’s
Manchester billings. The findings indicated a problem with balance billing. This issue
was much more widespread than previously thought. During the vendor presentations, it
was positioned that the billing issue was a local one and that with the new management
team these issues would not occur. AMR has established a local customer care office;
however, the main corporate billing office in Akron, Ohio still processes all Manchester
bills.
Contract Variables
Dispatch Reimbursement: Meets Requirements (2)
Oversight Reimbursement: Meets Requirements (2)
Usual and Customary Rates (UCR): Most Advantageous (3)
 While CarePlus’ UCR rates were the lowest by $100 per category, American Medical
Response did not propose a UCR charge for individuals where transport did not occur.
Medicare plus rates (Cost to Patient): Less Advantageous (1)
 American Medical Response’s Medicare plus rates (29%) were higher than American
Ambulance’s rates (25%), but lower than CarePlus’ rates (35%).
Total Evaluation Score
43
It is this evaluator’s opinion that the overbilling issue appears to be a systemic problem with
American Medical Response. Reports of billing discrepancies were found which date back to
2002. AMR was listed in a National Press Club report of “The Top 100 False Claims Act
Settlements” for a $20,000,000 settlement in a false claims allegation. In 2006, AMR paid the
United States over $9 million to settle a claim that the company violated the False Claims Act in
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American Medical Response Evaluation Sheet Explanation
Texas. A 2010 payment of nearly $1 million was made by AMR to settle an overbilling claim in
Spokane, Washington. More recently in 2011, AMR agreed to pay the United States a $2.7
million settlement to resolve allegations of submitting inflated claims in New York. As a result
of that settlement, AMR agreed to sign a Corporate Integrity Agreement (CIA). A review of the
Office of the Inspector General’s CIA list revealed 314 active Corporate Integrity Agreements
nation-wide since 2005. Of the 314 agreements, nine were from ambulance providers. American
Medical Response was listed as one of the nine. Rockingham Regional Ambulance’s case was
closed on May 3, 2013, thus reducing the list of ambulance companies to eight. It is not the
intent of this evaluator to allege any wrongdoing on the part of American Medical Response,
however, these examples serve, in this evaluator’s opinion, to illustrate the difficultly of a large,
centralized corporate billing and collections operation to control and meet the various billing and
collection requirements of local contracts. The range and breath of these billing issues appears to
this evaluator to be a function of a larger corporate process, rather than a local management
issue.
American Medical Response has been the nation’s largest ambulance provider for some time.
Recently, however, there have been operational closings and contract withdrawals which have
this evaluator wondering about the long term viability of AMR in the New England and
Manchester market. During the vendor presentation, it was stated that the Newburyport operation
was shut down for economic reasons. A search of federal WARN notifications revealed layoff
notices for nearly 1220 employees in the Sacramento, Concord, San Jose, San Rafael and San
Leandro, California areas between 2011 and 2012. This evaluator was unable to determine if
those layoffs actually occurred. Contract terminations and non-renewals have also occurred in
the NH and MA areas. Most recently, the New York State Department of Labor listed a WARN
notification for layoffs of 148 employees of AMR in their Long Island and Brooklyn, NY
operation. According to news reports, AMR will cease operations in Brooklyn on July 1 and on
Long Island on September 1, 2013. This evaluator is concerned over the long-term stability and
commitment of AMR to the New England and Manchester market.
It is this evaluator’s opinion that American Medical Response possesses the necessary local
resources, management ability and skilled providers to meet the service delivery requirements of
the Manchester emergency ambulance contract.
Based on the Comparative Selection Criteria, completeness of required information, vendor
presentation and contract variables, this evaluator cannot vote to recommend American Medical
Response as the 911 emergency ambulance provider to the Committee on Administration.
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