Judge OKs ambulance service switch - Ruling: San Bernardino County legally chose agency

on October 02, 2026

American Medical Response, the ambulance company that has been operating in San Bernardino county since the 1970s, expressed disappointment with the decision Wednesday afternoon. Beginning Thursday morning, AMR’s ambulance service was replaced by CONFIRE ambulance service.

“This contract award was driven not by service quality, patient outcomes, or the results of the county’s own competitive process — which AMR won — but by manipulating the award to increase county revenue and to exploit a controversial Medicaid loophole that federal regulators are actively investigating for fraud, waste, and abuse,” the company said in a statement released after the ruling was published.

“The county passed over the highest-scoring bidder who proposed 30 more ambulances per day and lower patient charges, instead choosing to substantially raise rates to chase a taxpayer-funded windfall,” the statement continues. “We continue to believe that emergency medical services contracts should be awarded based on who can provide the best care —not who can access the most favorable reimbursement loopholes.”

On Sept. 25, AMR made an eleventh-hour effort to stop the change, arguing in court that San Bernardino County was getting ahead of Robinson’s final ruling. Judge Jay H. Robinson expressed frustration with the county in court Tuesday, although he ultimately denied AMR’s request for a temporary restraining order.

Consolidated Fire Agencies, or CONFIRE, is a joint operation of 15 San Bernardino County fire departments.

In the statement, AMR wrote that CONFIRE, as a public agency, is able to charge a higher rate to Medicaid than private providers like AMR are allowed to charge.

This summer, the federal Centers for Medicare & Medicaid Services asked for public comment on a proposed rule change to eliminate the ability for state and local governments to effectively shift paying for their portion of Medicaid payments back onto the federal government.

If enacted, the new rule would go into effect Jan. 1, 2029.

AMR added, “This would eliminate the reimbursement structure on which the county and CONFIRE are relying, leaving the county responsible for potentially significant budget shortfalls even as residents face sharply higher ambulance charges.”

While pledging to transfer service to CONFIRE, AMR is “evaluating all appropriate legal and other next steps, including an appeal of this ruling,” the company’s statement concludes.

Meanwhile, San Bernardino County applauded Robinson’s ruling.

“We appreciate the court’s decision,” county spokesperson Lauren Howland wrote in an email. “We look forward to a successful transition to CONFIRE on Oct. 1 and, ultimately, to providing San Bernardino County residents with exceptional, reliable emergency medical care going forward.”

In December 2023, the San Bernardino County Board of Supervisors voted to end the contract with AMR. The board cited expected cost savings from the change, along with other efficiencies.

Three months later, AMR sued, arguing the board did not follow the federal and state legal process for awarding contracts. Supervisors chose CONFIRE despite its bid scoring fewer points in the county’s review and evaluation process, which AMR argued violated federal antitrust law.

Bidders were scored on 14 criteria, including system requirements, response time, equipment, personnel, disaster preparedness and more. AMR narrowly beat out CONFIRE, scoring 1,519 points to 1,515. Three of the four evaluators gave a higher score to CONFIRE, though, county staffers noted in their December 2023 presentation to the board.

In October 2024, Robinson agreed with AMR’s reasoning.

“By inventing a new procurement process, county defendants willingly broke free from the constraints of a state-approved process,” Robinson wrote in a preliminary injunction. “This decision amounted to an evidence-free policy change of ambiguous motivation.”

In December 2025, the Fourth Appellate District Court of Appeals published its disagreement with Robinson and reversed his temporary restraining order.

Then in May 2026, an injunction preventing the county from having CONFIRE take over ambulance services was lifted by the court.