Former Escambia medical director loses ruling in ambulance billing lawsuit, but case goes on

Escambia County's former Medical Director Rayme Edler lost a ruling in her lawsuit alleging the county committed fraud against the U.S. government.

U.S. District Judge Casey Rodgers dismissed a count of Edler's lawsuit alleging the county "upcoded" claims to programs like Medicare in billing for its ambulance service.

Rodgers ruled that Edler's complaint failed to meet the rule under the False Claims Act that requires "particularity" when it comes to the facts of any alleged fraud's time, place and substance.

That "particularity" can include first-hand knowledge of the alleged fraud.

Edler alleges evidence of the "upcoding" can be seen in Escambia County's Medicare billing data when billing for basic life support versus the higher-paying advanced life support, as compared to neighboring jurisdictions.

The lawsuit alleges Escambia County billed 74% of its claims for advanced life support compared to only 54% for other ambulance services in Santa Rosa County and Baldwin County, Alabama. The nationwide average for Medicare is only 40% of ambulance claims are advanced life support, according to the lawsuit.

That data was not specific enough to overcome the "particularity" requirement.

Bergosh text messages: Leaked Bergosh text messages mention EMS doctor who is suing Escambia County 102 times

Edler contends the allegations can be proven once the billing data in possession of Escambia County is gathered and is part of the lengthy discovery process in the case. Rodgers noted this but said the requirement for "particularity" set out in court precedents cannot be relaxed unless the person suing had direct knowledge or participated.

"Even though Edler, as medical director, may have had 'direct knowledge of the Escambia EMS Department’s business model, structure, equipment, staffing and training,' Edler did not work in the billing department and does not allege that she had firsthand experience in billing or tracking false claims or saw other employees draft or submit false claims," Rodgers wrote.

The dismissal of the count does not kill the lawsuit, as there are three other counts left to be litigated. Two of the counts relate to retaliation against Edler under the Family Medical Leave Act, and one count alleges the county submitted false claims for its ambulance with unlicensed personnel.

The county failed to get the false claims for unlicensed personnel dismissed in 2021 when Senior U.S. District Judge Roger Vinson, who died earlier this year, denied the county’s attempt to dismiss the lawsuit.

Vinson noted that under the False Claims Act at that stage of the litigation, he was required to assume the allegations were true and had to rule on if the complaint properly stated a legal claim.

Vinson said Edler’s attorney's argument for moving the lawsuit forward was “comprehensive and compelling,” and he rejected the county’s arguments as “unpersuasive.”

The lawsuit has spawned another legal drama as former county employee Jonathan Owens provided Edler's attorneys with a spreadsheet containing 52,486 text messages from Escambia Commissioner Jeff Bergosh. Owens worked directly for former Escambia County Commissioner Doug Underhill and unsuccessfully ran against Bergosh in 2020.

Judge allows messages: Leaked Bergosh text messages will be allowed in Edler lawsuit, judge rules

Edler's attorneys sought to use the messages in the lawsuit to aid in the relation claims against the county.

U.S. Magistrate Judge Hope Cannon ruled that the messages can be used in the suit once both parties go through a redaction process to determine what messages are relevant to the lawsuit and which ones are also public record.

The lawsuit is under an order to resolve all discovery issues in the next few months.

Meanwhile, the County Commission voted 4-1 on Thursday to seek legal action to halt the further dissemination of Bergosh's text messages. Bergosh said that would include filing an action against Owens.

County Administrator Wes Moreno said the county has been unable to determine how the messages ended up in Owens's possession.

Owens told the News Journal and has said publicly the messages were left on the desk of his county office by an anonymous person.

During Thursday's meeting, Bergosh said he was disgusted by what he called the theft of his text messages, which he said included private and personal information.

"There's 14 citizens not affiliated with my family that now have their medical information out there," Bergosh said. "This needs to be stopped, and we have to send a message here with this."

This article originally appeared on Pensacola News Journal: Escambia County Medical Director loses ruling in false claims lawsuit