Tuesday, October 03, 2006

State Fines New York Clinic $16.5 Million in Medicaid Inquiry

October 2, 2006

Some patients at a Queens substance abuse clinic who had only minor alcohol problems were given intensive treatments, four or five days a week, for up to two years, with Medicaid picking up the bill, investigators said. Other patients needed more serious psychiatric care but were instead kept in unnecessary treatments for chemical dependency, again at taxpayer expense.

The clinic, Community Related Services Inc., which investigators said specialized in treating elderly patients from the former Soviet bloc, was fined $16.5 million for overbilling the Medicaid system, Gov. George E. Pataki’s office said yesterday.

It was the largest fine levied by the state’s new Medicaid inspector general’s office, created last year to combat rampant abuse in the joint federal-state health care program for the poor.

The state also froze $30 million in payments to the clinic, on Queens Boulevard in Rego Park, and began proceedings to revoke its license.

The inspector general and the state’s Office of Alcoholism and Substance Abuse Services cited the clinic for what they said were 45 regulatory violations, like improper patient assessments and poor record-keeping, and issued 25 findings of “serious Medicaid fraud, waste and abuse.”

The clinic can request an administrative review or challenge the fine in court, said Henry Zwack, executive deputy commissioner of the alcoholism and substance abuse office.

State records say the clinic, a profit-making entity, is owned and operated by Dr. Yelena Mamedova-Braz, a psychiatrist, and Maya Gurevich. Phone calls were placed to both owners yesterday, but they could not be reached for comment.

The clinic was founded in 1998 in an area of Queens that has a large number of immigrants from the former Soviet Union. According to Mr. Zwack, the clinic treated about 600 people a day, most of them elderly women from Uzbekistan.

Investigators found that patients had visited the clinic an average of 152 times a year, compared with an average of 34 visits a year for other chemical-dependency centers regulated by the state. The state also determined that patients at the Queens clinic tended to stay in treatment an average of 20 months, compared with 3.7 months at other clinics.

The agency also cited the clinic for paying its counselors based on the number of sessions they had with patients, creating an incentive for counselors to overbill. This system contributed to the high volume of services for patients who seemingly had minor or negligible histories of alcohol and drug abuse, investigators wrote.

Mr. Zwack said that investigators had found some people who needed mental health services but were getting alcohol treatment instead, or no services at all. For some patients, he said, the clinic acted more as a “senior day care center, a place for people to come together, speak the same language and interact.” He also said that English courses offered by the clinic had been billed as treatment.

The clinic billed Medicaid an average of $11 million a year.

“What this company was sucking out of Medicaid could have provided care for 2,400 more patients who really needed it,” Mr. Zwack said.

According to the report by the substance abuse agency, the clinic made an interest-free loan of $3.52 million in 2004 to another company that Dr. Mamedova-Braz and Ms. Gurevich owned, Advanced Community Services Inc., after the owners became aware of an investigation by the office of the state’s attorney general, Eliot Spitzer. When asked about the loan, Ms. Gurevich told investigators that it was made to ensure that they had money in case the clinic’s money was seized, the report said.

Mr. Zwack said that Dr. Mamedova-Braz was in the process of trying to get licensing for another mental health clinic. But if the Queens Boulevard clinic loses its license, Mr. Zwack said, she and Ms. Gurevich could be permanently barred from the Medicaid system.

Investigators found other problems as well, including what they said was poor record-keeping and what they described as the unethical treatment of patients. According to an agency report, Russian-born counselors referred to themselves as “real Russians” and made disparaging comments about the ethnic backgrounds of their patients.

In justifying extensive treatment programs, the clinic’s director-owner, Dr. Mamedova-Braz, told investigators that her patients had limitations due to intermarriage. “These marriages, according to Dr. Braz, produce generation after generation of mentally disabled individuals who lack the capacity to function successfully and independently,” investigators wrote.

Mr. Zwack said, “It’s just not the kind of description any of us would expect a doctor to have.”

Billing irregularities were initially discovered by the state attorney general’s Medicaid Fraud Control Unit, Mr. Zwack said. A spokesman for the attorney general, Darren Dopp, declined to comment on whether the clinic was still under investigation.

The governor created the inspector general’s position and appointed Kimberly O’Connor, a former prosecutor in Schenectady County, to fill it last year after articles in The New York Times detailed widespread abuse and poor oversight in the state’s $45-billion-a-year Medicaid program.

This year, at the governor’s urging, the Legislature set aside money for 81 positions to monitor Medicaid fraud. But in a report in June, auditors with the federal Department of Health and Human Services said that Mr. Pataki’s changes, while laudable, were not sufficient to make up for years of staff cuts and lax enforcement.

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