Macedon officials did not adequately oversee ambulance billing and spending, a state audit found, leaving thousands of dollars in unapproved write-offs and purchases without the competition required by town policy. The town said it accepts the findings and has begun changing its procedures.
The state comptroller's audit, released this month, reviewed the Wayne County town's ambulance finances from January 2024 through April 15, 2026. It found gaps in billing, budgets, claims approval, purchasing, payroll and inventory controls. Auditors did not conclude that the identified amounts were stolen or lost.
Billing went without town reconciliation
Macedon uses a third-party company to bill and collect ambulance charges. Auditors said town officials had not reconciled patient care reports and 911 call logs with the company's bills, and had not routinely reviewed its collections or write-offs. The town supervisor told auditors she had reviewed billing reports as bookkeeper until 2016 but stopped when she left that role.
For December 2024 and December 2025, the company billed 141 patients $235,902. It collected $197,086 in full or partial payments from 128 patients, while $21,496 remained outstanding as of March 12, 2026. It wrote off 21 billed amounts totaling $17,320 without Town Board approval, auditors found. Those figures reflect the two months examined, not all ambulance billing during the audit period.
The audit also identified possible mileage billing errors: nine patients may have been overcharged a combined $793, and five may have been undercharged $218 because the wrong starting point was used. The board adopted an updated ambulance fee schedule April 9, after auditors asked for documentation of its prior approval of rates.
Purchasing and payroll controls questioned
Auditors found that the ambulance director did not obtain required verbal or written quotes for 14 purchases totaling $59,674. They also said officials did not verify that a $173,000 ambulance purchase met each legal condition for using another governmental purchasing contract. The board had not sought competition for ambulance billing services since 2010, the report said.
The board did not review or approve 17 ambulance-related claims totaling $13,552 that the supervisor paid in December 2025. Town records also showed one emergency medical technician received $2,114 more than the board-approved pay rate over the period examined. Auditors said the service lacked written supply inventory records and up-to-date financial reports for the board.
The town's 2026 budget anticipated $500,000 in ambulance charges against $891,104 in appropriations. Auditors said the lack of current financial information made it harder for the board to gauge how much of the service was supported by fees versus other town revenue and to plan for future costs.
In a Sept. 15 response included with the report, Supervisor Kim Leonard said Macedon did not dispute the findings. She said the town now receives monthly billing statements for reconciliation, has brought its accounting records current through August and filed annual financial reports covering 2016 through 2025. The town is revising billing and claims procedures and plans to create a five-year capital plan, she wrote.
Leonard said the EMT pay-rate discrepancy arose after an employee returned from workers' compensation leave without an updated board resolution. She also acknowledged that the December claims should not have been paid before board approval. The comptroller made 15 recommendations and said the board must submit a written corrective-action plan within 90 days.
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