Former paramedic's 'upcharge fraud' leads to audit of Everett Fire Department

EVERETT, Wash. — An exclusive KIRO 7 Investigation has uncovered new information about David "Pete" Vier, the City of Everett Fire Department's former Chief of Emergency Medical Services who's been charged in King County with plotting to have sex with a teenager.
 
Multiple anonymous sources within the department, and senior paramedic Pete McFall, all told KIRO 7 that Vier forced them to commit what they believe may have been Medicare fraud, and that it went on for years. KIRO 7 has learned those same claims eventually resulted in an audit.  
 
According to 33-year department veteran McFall, every paramedic was forced by their supervisor, then-Chief Vier, to bill Medicare at the highest rate possible for even the most basic services.

"I think that might likely constitute fraud," McFall told KIRO 7 recently.
 
The new information is in addition to Vier's reported history of being investigated within the past few years for stalking, domestic violence assault, mental instability and an alleged on-the-job suicide attempt in July of 2011.

The multiple sources also claimed that Vier's "bully" tactics were not only tolerated by higher-ups at the Everett Fire Department, but were possibly encouraged in order to make money for the City of Everett at taxpayer expense.
 
The 60-year old Vier retired in shame last December, weeks after he was arrested by the Seattle Police Department for allegedly arranging to meet with someone he thought was a 15-year old girl for paid sex. 
 
Just months from retirement himself, McFall is very outspoken about the Medicare billing practices he claims Vier forced upon him and the other paramedics.

Reporter Amy Clancy: "What was Vier's involvement in all this?"  
McFall:  "He was directing us to do it."

Other Fire Department paramedics, who wouldn't talk on-camera for fear of losing their jobs, told KIRO 7 similar stories.

Clancy: "In your estimation, what was it that Vier was making you all do?"  
Confidential Informant #2:  "Fraud."
Clancy:  "Defrauding whom?"  
Confidential Informant #2:  "Both the taxpayers and the federal government."

KIRO 7’s multiple sources all said that from at least 2011 to mid-2013, as Chief of Emergency Medical Services, Vier ordered them all to fill-out paperwork for each Medicare hospital transport by checking only the box for "Advanced Life Support," or ALS --- instead of "Basic Life Support" -- even when only basic services were provided.

And if they didn't?

Confidential Informant #1 told Clancy:  "He would change the box.  He would re-check them to a higher box if you marked them BLS. Vier would change them to ALS."
Confidential Informant #2 said Vier "was very heavy-handed in the billing and Medicare.  And I think they (the administration) kept him in that position because he was bringing money to the City."

Pete McFall described what was happening this way: “If the little old lady who’s got a broken leg goes to the hospital in a private ambulance, she pays $500.  But if I take her, she pays $800.  Why is that?”

All of KIRO 7’s sources said the Everett Fire Department charged Medicare up to $300 more per trip as a result of Vier’s demands.

An email provided to KIRO 7 by a source confirms that many paramedics raised concerns about the way Vier's department was billing.  In the email thread, the paramedics were informed by the department, that "if a medic transports, it is billed as ALS" -- at the higher rate.

One paramedic even asked via email "are you sure this isn't some kind of up charge fraud"?  Another was told "all medic transports are ALS because we're so special."

McFall said he was told the same thing:  “because you’re a paramedic, that’s the only way you can bill.”

The sources all said the alleged "up-charging" ended shortly after the email thread leaked to KIRO 7 was distributed throughout the department in 2013. By that time, an audit was finally being done to investigate the Medicare billing allegations, at the request of at least two employees in the City’s billing department.

According to documents obtained by KIRO 7 through a public records request, one billing employee often spoke-out about “our lack of compliance with the rules and requirements of Medicare” and insisted "to continue to bill in a manner that you know is wrong is fraud."

Another now-retired employee wrote in a 2012 email "The fire department has been out of compliance with Medicare/Medicaid claims requirements since I arrived there and I have worked very hard, first to learn the rules and then to try to encourage the implementation of the changes that would bring us in to compliance."  That now-retired employee also wrote: "The focus of the department is on the revenue and little to no interest has been placed on the compliance."
 
Despite the claims of the paramedics and the billing department employees, the Pennsylvania firm hired to conduct the audit found -- not fraud --- but that the fire department was "improperly billing patients and their insurers for ancillary services already covered in the Medicare base rate payment."  The audit also determined "It is highly possible that Everett owes refunds to patients."  The City of Everett was told this "double-dipping" "must be stopped".
 
Which came as a surprise to Pete McFall and all of KIRO 7's other sources within the department.

Clancy asked McFall: "How can it be stopped if even the senior paramedic doesn't know that it was an issue?"
Pete McFall:  "We haven't been given any direction otherwise.  We're still billing the same way.  We're still billing for all those ancillary charges, as far as I know."
Clancy asked Confidential Informant #2: "have you heard of any refunds being given?"
Confidential Informant #2 replied, "no."

KIRO 7 made multiple requests to interview Everett’s Mayor, Ray Stephanson, and Fire Chief Murray Gordon to ask whether any patients had received the refunds called-for in the audit.

No one from the City would agree to an on-camera interview. In fact, Chief Gordon sent an email throughout the Everett Fire Department to prevent anyone else from speaking on the record either, reminding them that "employees are required to keep confidential any information about City business or personnel that is not commonly available to the public."  Click here to see leaked email. 
 
City spokeswoman Meghan Pembroke did send KIRO 7 an email that said the audit "exonerated the City and showed to Medicare fraud was occurring." Click here to see email.

However, all of KIRO 7's sources claim the information the City provided for that audit included only the numbers from after the alleged "up-charging" had already stopped.
 
So what does Pete Vier have to say about all the controversy surrounding him? A KIRO 7 crew visited his Arlington home last month seeking comment.  No one answered the door, although voices could be heard inside.

Want to talk about the news of the day? Watch free streaming video on the KIRO 7 mobile app and iPad app, and join us here on Facebook.

Cox Media Group