Probe into Medicaid
BY RICK BRAND, Newsday, December 7, 2005

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A Suffolk grand jury has subpoenaed applications of thousands of Medicaid recipients who have enrolled in the past 2 1/2 years, as part of an investigation into the nearly $1.4-billion-a-year county program.

The subpoenas, issued in October, sought enrollment records and other documents between January 2003 and last July from the county's managed health plan for the poor and five private health plan providers that enroll patients in the county's Medicaid program.

A spokesman for District Attorney Thomas Spota declined to comment. County sources and some of the providers confirmed the subpoenas.

The six health plans sign up nearly 1,100 of the 3,650 new patients that the county processes on average each month. Suffolk's Department of Social Services enrolls the rest directly and makes final decisions on eligibility for all applicants. Suffolk has about 130,000 people enrolled in Medicaid.

County Executive Steve Levy said he welcomed the subpoenas. He said the probe is aimed at both enrollment problems and health care providers who are overbilling the county. "If there is waste and fraud in the system, we wanted it weeded out. Taxpayers are footing the bill," he said.

The subpoenas came after Spota, Levy and Comptroller Joseph Sawicki held a news conference in September to announce extra Medicaid investigators and the empaneling of a grand jury to probe Medicaid abuses and school corruption.

Experts say that Medicaid abuse may cost as much as 10 percent of the state's $44.5-billion Medicaid bill. Nationally, federal officials say, in 2003 states recovered $268 million.

According to one subpoena obtained by Newsday, the Suffolk district attorney's office is seeking 17 different types of documents.

Dennis Nowak, social services spokesman, said the agency, which administers the Medicaid program, relayed to Spota's office concerns about the Medicaid program and is cooperating fully. He said three social services employees have testified before the grand jury. The federal Medicaid program, under which the county pays 25 percent, cost Suffolk $274.4 million last year.

County health officials say they have turned over more than 5,000 enrollment applications for the department-run Suffolk Health Plan, an HMO that operates out of the county health centers. Spokeswoman Millie Dinda said the agency is cooperating fully, but knew of no problems with their 17,000-client operation.

Private health providers - Health Insurance Plan and Fidelis Care - acknowledged receiving subpoenas and officials say they are cooperating. Two other companies, HealthFirst and Affinity Health Care, did not return calls. A spokesman for United Health Care declined comment.

"We were among several plans that received subpoenas," said Ron Mairono, a HIP spokesman. "We responded by providing the documents that were requested." Darla Shattenkirk, a spokeswoman for Fidelis, said they also complied with the subpoena, "but it is our understanding we are not a target."
Copyright 2005 Newsday Inc.

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