North Dakota
North Dakota ambulance providers losing money on every run, according to survey
By: Michael Achterling
FARGO (North Dakota Monitor) – North Dakota ambulance service providers lost nearly $500 on average for every patient transported to a medical facility last year, according to a survey.
The recent survey of three dozen providers in the state, conducted by PWW Advisory Group, was the result of a study created by House Bill 1322 passed during the 2025 legislative session. The group presented the results to the Legislature’s interim Emergency Response Services Committee on Wednesday.
The average revenue generated from an ambulance transport was about $1,100 during 2025, but the expenses were nearly $1,600, said Matt Zavadsky, an EMS and mobile health care consultant with PWW, based in Pennsylvania.
“They are losing money every time they respond to a call,” Zavadsky said during the meeting. “That financial loss has to be made up, typically, by local tax subsidies, fundraisers, bake sales, or all too often, service reductions to try and match expenses with the revenue they can generate.”
He said the problem cannot be fixed by billing reform alone because the revenue generated isn’t enough to fund the cost of readiness, such as personnel, equipment and supplies, among other items.
The survey highlighted 74% of ambulance provider expenses went to personnel costs, but equipment costs have also increased in recent years.
Zavadsky said survey respondents plan to invest about $12.9 million into vehicle and equipment purchases over the next five years, averaging to about $358,000 per provider. However, the cost of a new ambulance has risen to between $275,000 to $480,000 per vehicle. Prior to the COVID-19 pandemic, a new ambulance could cost up to $250,000, he said.
There are more than 100 ambulance service providers in North Dakota. The 36 survey respondents represented a diverse group of providers from city and county services to district-owned, hospital-based and private providers, he said. The average patient transport distance is 34 miles, according to the survey.
Zavadsky said the survey respondents reported 53% of their total revenue was generated from fees for service with the remaining 47% coming from local tax subsidies, state grants and other fundraising.
“What you guys are experiencing in North Dakota and what is happening in the local communities … is not the fault of the local communities, not the fault of the state, this is just our new normal,” Zavadsky said.
Rep. Todd Porter, R-Mandan, owner of Metro-Area Ambulance Service which serves Morton and Burleigh counties, said Medicare patients reimburse ambulance providers at a much lower rate than private insurance and Medicaid patients. He added Medicare patients make up about 60% of the call volume in the Bismarck-Mandan area.
“If we’re being underpaid for 60% of our call volume, then we have to make it up some place,” Porter said.
He said some providers can make up that difference in reimbursement with tax dollars, but not all providers have that option.
“We do other contracted work for nursing homes, hospitals, funeral homes in order to make up that difference,” Porter said. “This is a federal government problem. This is a CMS (Centers for Medicare and Medicaid Services) problem that we’ve known about for years.”
Porter also said ambulance services are not reimbursed for responding to a call with a Medicare patient that doesn’t require a transport to a hospital. According to the survey, about 17% of all ambulance calls don’t require transport to a medical facility.
The survey also showed about 2,300 of the nearly 33,600 patient transports billed last year ended up in collections after being more than 90 days delinquent, totalling $2.7 million, Zavadsky said. The average total of a claim sent to collections was about $1,100.
Zavadsky estimated the total of unpaid claims for more than 100 providers across North Dakota was about $5.8 million in 2025. Some providers don’t have procedures to pursue delinquent billing in collections, he said.
Rep. Jim Grueneich, R-Ellendale, chair of the committee, said the committee will take a deeper look at the data presented on Wednesday and may have recommendations, and possible draft legislation, to address the issue in the 2027 legislative session.
Greg Power, fisheries division chief with the North Dakota Game and Fish Department, shares information about the new 2026-2028 Fishing Guide and a few new regulations starting April 1, 2026.
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SIOUX FALLS — Ali Stephens had 17 points and 13 rebounds and 8th-seeded Omaha defeated 9th-seeded North Dakota 49-39 in the first round of the Summit League women’s tournament.
The Fighting Hawks had a tough time putting the ball in the hoop all night long, scoring just three points in the first quarter and having only marginally better luck from there.
UND (7-24) shot just 23.5 percent from the floor (12-for-51) and made 1-of-20 shots from outside the arc. Walker Demers and Mackenzie Hughes had 10 points each to lead the Hawks, with Demers adding eight rebounds.
Matt Zimmer/Sioux Falls Live
Regan Juenemann had 10 points and five rebounds for the Mavericks while Avril Smith had seven points and 16 rebounds and Sarai Estupinan eight points, five assists and three rebounds. Omaha (6-26) shot the ball slightly better than the Hawks, going 16-of-53 from the field (30 percent) and 8-of-23 (35 percent) on 3-pointers.
With the win, the Mavs earn a date with top-seed North Dakota State on Thursday at 2:30 p.m.
The Bison won both regular season matchups by more than 50 points.
Matt Zimmer/Sioux Falls Live
Oral Roberts 84, Kansas City 62 — Don’t look now but the team that started the conference season 0-10 and at one point lost 15 of 16 games might be the hottest in the Summit League.
Oral Roberts picked up their fourth straight victory on Wednesday night in the conference tournament opener, routing Kansas City at the Premier Center in the 8/9 “play-in” game.
Ty Harper had 22 points to lead the Golden Eagles (10-22), who took a 44-21 lead by halftime and never looked back. ORU shot 50 percent from the floor and made 13-of-27 3-pointers while the Kangaroos shot just 34 percent and made 6-of-24 from deep. Martins Kilups had 17 points for the Eagles and Connor Dow added 14.
Jayson Petty had 14 points to lead the Kagaroos, who finish the season 4-27. It was their final game under coach Marvin Menzies, whom the school announced earlier this season would not return next year.
With the win ORU advances to face top-seed North Dakota State on Thursday at 6 p.m.
The Golden Eagles lost to NDSU 86-58 in Tulsa on Jan. 24 but they took the Bison to overtime in Fargo on Jan. 3 in a 79-77 loss.
Matt Zimmer is a Sioux Falls native and longtime sports writer. He graduated from Washington High School where he played football, legion baseball and developed his lifelong love of the Minnesota Twins and Vikings. After graduating from St. Cloud State University, he returned to Sioux Falls, and began a long career in amateur baseball and sports reporting. Email Matt at mzimmer@siouxfallslive.com.
North Dakota
The North Dakota Attorney General issued an opinion to the ND State Auditor – North Dakota Attorney General
04 Mar The North Dakota Attorney General issued an opinion to the ND State Auditor
in Opinions
March 4, 2026
Media Contact: Suzie Weigel, 701.328.2210
BISMARCK, ND – It is the opinion that federal law does not prevent the state from auditing P&A and even though P&A possesses confidential records, N.D.C.C. § 54-10-22.1 and 42 C.F.R. § 51.45(c) authorize the state auditor and the employees of the auditor’s office, to review the records without detriment to P &A.
Also, whether Rule 1.6 of the North Dakota Rules of Professional Conduct for licensed attorneys prohibits P&A from disclosing to the State Auditor the contents of a client file for the purpose of conducting a non-financial performance audit under N.D.C.C. ch. 54-10 when the requested file includes information about individuals and businesses in the private sector who chose to contact P &A.
This issue was already addressed in a 1995 opinion of this office regarding P&A. The 1995 opinion highlighted that P&A has authority to contract with private attorneys to represent private individuals. 17 During that performance audit, auditors asked to see billings from the contracted attorneys. 18 P&A redacted the names of the individuals represented by the contract attorneys under the rules for attorney-client privilege or attorney-client confidentiality. 19 The names of individuals seeking services of P&A are protected under N.D.C.C. § 25-01.3. The opinion stated:
Thus, P&A’s records which indicate to whom its services were provided are available to the State Auditor for performance audit purposes. The State Auditor has
been given access by P&A to its records other than the attorney’s billings. Therefore, the State Auditor already has access to the names of the persons to whom P&A
provides services. State law requires that the State Auditor and his employees must keep such information confidential.
Here, P&A has not identified a specific record. Given that, I rely on the past opinions declaring that records made confidential by N.D.C.C. § 25-01.3-10 are available under N.D.C.C. § 54-10-22 to the State Auditor and the Auditor’s employees for audit purposes.
Link to opinion 2026-L-01
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