Dentist theft case reveals huge Medicaid fraud

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The Independent US

Dr Dolly Rosen and an associate face charges of grand theft after her claims in 2003 for reimbursement from Medicaid, which is aimed at helping poor people get access to treatment, suggested that on one day she treated 991 patients.

After an intensive investigation, The New York Times asserted yesterday that fraud and abuse of the programme was costing billions of dollars every year.

The scams, rarely detected by state auditors, come in a bewildering number of varieties. There are the executives of retirement homes accused of accumulating extravagant salaries from Medicaid while skimping on nursing staff. Then there are the doctors routinely ordering costly ambulette vans for patients deemed unable to take public transport when many are perfectly capable. And there are the specialists prescribing steroids designed to bulk up Aids patients that are sold on the black market to body builders.About 4.2 million people depend on New York state's Medicaid programme. But it has become increasingly the target of blatant abuse and profiteering.

New York spends $45bn a year on Medicaid, about half of which is provided by the federal government and the remainder by the state's own taxpayers. No other state comes close. Even California spends less on Medicaid, despite covering 55 per cent more patients.

James Mehmet, a former chief investigator of Medicaid fraud in New York City, told The New York Times that as many as 10 per cent of claims could be considered fraudulent, while another 20 to 30 per cent arose from abuse that may not be criminal. "So we're talking about 40 per cent of all claims being questionable," Mr Mehmet said. Under that scenario, taxpayers are being defrauded by as much as $18bn (£10bn) a year.

Few in the industry may have been as brazen as Dr Rosen, who was arrested earlier this year after The New York Times analysed her claims and tipped off the authorities. She and her associates have been accused of stealing more than $1m from the programme.

It is alleged that 80 per cent of the time, the procedures Dr Rosen said she performed never happened, were unnecessary or improper. She was undetected until the newspaper sounded the alarm. In 2003 she was making higher claims than any of the 50,000 other dentists participating in the Medicaid programme. Her billings were $1m more than the next highest.

The newspaper also highlights a Brooklyn doctor who prescribed $11.5m worth of the anti-wasting steroid Serostim, a drug which is much used by bodybuilders.

It also points to the schools official in Buffalo who attracted Medicaid dollars to her school district by dispatching 4,443 students into speech therapy programmes in a single day.

State officials insist they are making headway in the battle to prevent Medicaid fraud. "This continues to be an area where we think that we have made substantial progress," said Dennis P Whalen, a senior executive in the State Health Department. "But by no means are we sitting back and resting on the accomplishments that we have made."