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.

A North Dakota judge has said he will order Greenpeace to pay damages expected to total $345m in connection with protests against the Dakota Access oil pipeline from nearly a decade ago, a figure the environmental group contends it cannot pay.

In court papers filed Tuesday, Judge James Gion said he would sign an order requiring several Greenpeace entities to pay the judgment to pipeline company Energy Transfer. He set that amount at $345m last year in a decision that reduced a jury’s damages by about half, but his latest filing did not specify a final amount.

The long-awaited order is expected to launch an appeal process in the North Dakota supreme court from both sides.

Last year, a nine-person jury found Netherlands-based Greenpeace International, Greenpeace USA and funding arm Greenpeace Fund Inc liable for defamation and other claims brought by Dallas-based Energy Transfer and subsidiary Dakota Access.

The jury found Greenpeace USA liable on all counts, including conspiracy, trespass, nuisance and tortious interference. The other two entities were found liable for some of the claims.

The lawsuit stems from the pipeline protests in 2016 and 2017, when thousands of people demonstrated and camped near the project’s Missouri River crossing upstream of the Standing Rock Sioux Tribe’s reservation. The tribe has long opposed the pipeline as a threat to its water supply.

Damages totaled $666.9m, divided in different amounts among the three Greenpeace organizations before the judge reduced the judgment. Greenpeace USA’s share of that judgment was $404m.

Energy Transfer previously said it intends to appeal the reduced damages, calling the original jury findings and damages “lawful and just”. The Associated Press contacted the company for comment on the judge’s Tuesday action.

In a financial filing made late last year, Greenpeace USA said it does not have the money to pay the $404m ordered by the jury “or to continue normal operations if the judgment is enforced”. The group said it had cash and cash equivalents of $1.4m and total assets of $23m as of 31 December 2024.

Greenpeace declined to comment on the judge’s filing, but Greenpeace USA interim general counsel Marco Simons reiterated that the organization could not afford the judgment.

“As mid-sized nonprofits, it has always been clear that we would not have the ability to pay hundreds of millions of dollars in damages,” Simons said Wednesday.

Simons added that the case is far from over and expressed optimism about the group’s planned appeal.

“These claims never should have reached a jury, and there are many possible legal grounds for appeal – including a lack of evidence to support key findings and valid concerns about the possibility of ensuring fairness,” Simons said.

Greenpeace has said the lawsuit is meant to use the courts to silence activists and critics and chill first amendment rights. The pipeline company has said the lawsuit is about Greenpeace not following the law, not free speech.

At trial, an attorney for Energy Transfer said Greenpeace orchestrated plans to stop the pipeline’s construction, including organizing protesters, sending blockade supplies and making untrue statements about the project.

Attorneys for the Greenpeace entities said there was no evidence for the oil company’s claims, and that Greenpeace employees had little or no involvement in the protests and the organizations had nothing to do with Energy Transfer’s delays in construction or refinancing.

CLIFFORD, N.D. (KFGO) – One man suffered serious injuries after a head-on crash in Traill County Tuesday morning.  

The Highway Patrol says the crash happened around 10:10 a.m. on an ice-covered Highway 18 eight miles east of Clifford. 

The 46-year-old from the Grand Forks Air Force Base was driving a van west when the van collided with an eastbound semi. The driver of the van was flown to Sanford Medical Center in Fargo by Sanford AirMed. The 42-year-old Larimore man driving the semi was not hurt.  

Both men were wearing seat belts.

The Traill County Sheriff’s Office, Mayville Fire and Rescue, and Sanford Ambulance also responded to the scene.