Buried deep in the Oak Bluffs annual town report is a line item called the ambulance reserve fund. For much of the past decade, the fund has held hundreds of thousands of dollars for the town, allowing it to purchase and equip fire and EMS thanks to substantial revenue, most of it generated by crucial off-Island ambulance runs.

Oak Bluffs ambulance finances have come under scrutiny in recent weeks, as news came to light that the FBI has opened an investigation into town ambulance billing practices. Some members of the combined fire and EMS department were subpoenaed to appear before a grand jury this past Tuesday. Town leaders have said they are conducting their own internal audit of the department’s finances.

The town recently admitted that it overbilled approximately $37,000 in reimbursements from ambulance runs that did not terminate at Medicare or Medicaid facilities. They are currently working with Comstar, their third-party ambulance billing agent, to credit back the funds.

Oak Bluffs is the only town on the Island to have a specific ambulance reserve fund. According to Bill Vrooman, who serves on the town finance committee, the fund was originally enacted because Oak Bluffs makes hundreds more off-Island ambulance runs than any of the other four ambulance services on the Island, resulting in higher revenues as well as expenditures. The Martha’s Vineyard Hospital, where most of the runs originate, is in Oak Bluffs.

Although he was not on the finance committee when the ambulance fund was enacted nearly three decades ago, Mr. Vrooman said he believed it was intended to be a bucket to store money and to help pay for expenditures, like new ambulances or equipment.

The ambulance reserve fund is consistently the largest of the town’s 12 or so revolving funds.

“The fund was established because of all the transports that Oak Bluffs does that all the other towns don’t do. It’s made up of the reimbursements we get for those runs,” Mr. Vrooman said. “It’s been around a long time, frankly.”

The fund was created by an act of the legislature and signed into law in November 1993, under Chapter 44 of Massachusetts General Laws that allows towns to establish special reserve funds separate from their general fund.

The original fund was limited to $12,000, plus enough money to buy an ambulance, if needed. 

“The town of Oak Bluffs may establish in the town treasury a reserve . . . in which shall be deposited all monies received from the provision of ambulance services until sufficient monies are deposited to allow for the purchase of an ambulance and in each year after such purchase until twelve thousand dollars has been accumulated for future purchases,” the authorizing act reads.

In 1999, the act was expanded to include a definition for those “future purchases,” specifically describing them as the equipment for public safety vehicles for the police and fire departments, and for the payment of EMT compensation for ambulance transportation outside Dukes County. 

In 2008, a third amendment removed the ceiling, allowing the town to deposit into the fund all money received from the provision of its ambulance services.

By the end of 2009, the amount in the fund had risen to $171,504, according to the 2010 town report.

The amount reported in the annual reports is the balance in the fund after appropriations have been made for equipment, including new ambulances and other public safety vehicles, often in the hundreds of thousands of dollars.

Over the last four fiscal years, for example, the amount in the fund reported in the annual report has ranged between $300,000 and $700,000. But the total amount brought in during those years averaged about $1.6 million, with a high of $1.75 million in fiscal year 2019.

Despite the seemingly high numbers, Mr. Vrooman and selectman Greg Coogan said the fund is less lucrative now than it has been in the past, partly because Medicare reimbursements have gone down. 

“It’s always been a fund to help the town out, although Medicare rules have changed a whole lot to where it’s not a big help as it used to be,” Mr. Coogan told the Gazette in a voicemail message. “It’s a lot of work for the town to do right now for not a lot of reward.”

According to a Comstar report provided by Oak Bluffs town accountant Deborah Potter, the town conducted 1,346 off-Island runs in the 2017 fiscal year, 1,258 in the 2018 fiscal year and 1,443 in the 2019 fiscal year. Mr. Vrooman said that while the number of runs has fairly remained consistent or increased, the reimbursements have not.

“It used to be that this was a very nice cash cow, but it’s not what it used to be,” Mr. Vrooman said. “One of the problems that has been established is that if we pick up a patient at the hospital and take them to Woods Hole, we get no reimbursement.”

The contractual arrangement between the town and the Martha’s Vineyard Hospital with regard to ambulance services remains unclear. A one-page agreement with the hospital that dates to 2004 states that Oak Bluffs has the first right of refusal on all ambulance calls, but hospital spokesman Katrina Delgadillo said in an email this week that the agreement has not been renewed.

Ms. Delgadillo said the only agreement between the hospital and town is limited to “MVH emergency department physicians serving as clinical resources for paramedics in the field, if necessary.” She said the hospital has identical agreements with each ambulance service on the Island. 

Mr. Vrooman said he was not aware of a written agreement between the town and hospital, but he believed there was a tacit understanding that Oak Bluffs conducts most of the ambulance runs.

“Basically, when they want ambulance services, Oak Bluffs provides it,” he said.

Fire chief John Rose, who was back on the job this week after serving a recent suspension by the selectmen as part of a settlement over sexual misconduct allegations, did not return a telephone call and text message from the Gazette seeking comment.

Mr. Vrooman said the finance committee does not regularly conduct deep dives into the fund, but that they do review it during their meetings.

The town had $83,795 in the fund at the end of the 2019 fiscal year, according to documents provided by Ms. Potter.

In a statement earlier this month that acknowledged the FBI inquiry into the ambulance fund and the Medicare billing mistakes, town administrator Robert Whritenour said the town has not found any other problems.

“No one has been charged with any wrongdoing. No individual has been identified as the target of the investigation. There has been no suggestion that the medical care provided by our EMS providers has been compromised in any way. There has been no suggestion of any self-dealing or diversion of funds by any individual,” he said.

Barry Stringfellow contributed reporting.