Metro

Rai$ing the dead in Medicaid ‘rip-offs’

Paging Dr. Frankenstein.

A massive state audit claims that health-care providers billed Medicaid for services provided to 287 dead patients.

Sixty-six providers — including hospitals, pharmacists and doctors — admitted their patients were “deceased at the time of service” when confronted by state Medicaid Inspector General James Sheehan’s office, The Post has learned.

In one shocking case, the office discovered that Bellevue Hospital in Midtown accepted a cadaver for its organs — and then sent a bill to Medicaid for the “treatment.”

Sheehan said Bellevue “received the body of a deceased Medicaid patient to harvest organs for transplant — but billed Medicaid as though they were treating the live patient.”

The patient had been transferred to Bellevue in a “clinically dead state” last April but was connected to life-supporting equipment “awaiting the removal of organs/tissue for donation,” a Bellevue spokesman said.

“The Medicaid program was mistakenly billed for the admission. When this was discovered [by the audit], the reimbursement was voided and returned to Medicaid.”

Following the investigation, Bellevue issued a new policy prohibiting staffers from billing Medicaid for harvesting organs or issues from brain-dead patients.

Sheehan said his office’s “deceased-patient project” found other examples of people making money off the dead using Medicaid, the $50 billion taxpayer-financed insurance program for the needy:

* One dead patient’s Medicaid card was used at three dentists in a week.

* Providers billed Medicaid for “scheduled patients” before actually treating them.

* A family accepted delivery of a new bed paid by Medicaid after the patient died.

* A doctor requested delivery of his patient’s prescription to his office after she died.

The Office of the Medicaid Inspector General examines Medicaid records for deceased patients.

The recent cases cost the agency less that $1 million, but the OMIG says every dollar counts in a tight state budget.

“We don’t want providers billing for dead people,” said OMIG spokeswoman Wanda Fischer.

Sixty-six providers, including Bellevue, told the OMIG that they billed Medicaid for dead patients as a result of honest clerical errors.

About 200 other providers suspected of improper billing insisted they had billed for services offered while their patients were alive.

Providers who cooperated with the audit and admitted problems were allowed to make amends to avoid being booted from the Medicaid program.

On the OMIG’s Web site, Sheehan posted the names of 11 providers it says failed to respond to certified mail or phone calls about questionable cases.

A lawyer for one of the providers, JVJ Pharmacy in Greenwich Village, said it had contacted the OMIG in a “timely manner.”

He noted that many of the pharmacy’s prescriptions are sent to nursing homes on a monthly basis for Medicaid patients. Often when a patient dies, there’s a time lag before the pharmacy is informed, he said.

He said JVJ has records that show it acted appropriately.

The following providers failed to respond to the OMIG’s December 1, 2009 letter as of the date of this posting. The OMIG has confirmed the beneficiary was deceased prior to the claim service date.

Provider Name Provider Type Location
JVJ PHARMACY INC PHARMACY NEW YORK
WALGREEN EASTERN CO INC PHARMACY OUT OF STATE
ONG KENNETH MD PHYSICIAN ROCKLAND

The following providers failed to respond to the OMIG’s December 1, 2009 letter and to follow-up phone calls from OMIG staff as of the date of this posting. The OMIG is awaiting formal death certificates to confirm that the beneficiary was deceased prior to the claim service date, although there was a reported date of death.

Provider Name Provider Type Location
C&C HOMECARE INC MEDICAL APPLIANCE DEALER NASSAU
HOME MEDICAL SPECIALTIES INC MEDICAL APPLIANCE DEALER QUEENS
CVS ALBANY, L.L.C. PHARMACY OUT OF STATE
RITE AID OF NEW YORK INC 3526 PHARMACY KINGS
CHEUNG CEDRIC P MD PHYSICIAN BRONX
EGAN DANIEL MD PHYSICIAN NEW YORK
MUSTACCHIA PAUL J MD PHYSICIAN NEW YORK
TEFERA LEMENEH MD PHYSICIAN NEW YORK

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carl.campanile@nypost.com