Fifth Avenue Doctor Admits To $350,000 Medicaid Scam

Attorney General Spitzer today announced that a Manhattan physician who formerly ran a Fifth Avenue abortion and family planning clinic has admitted to double billing taxpayers for patient visits, as well as billing for patients treated by other physicians.

Dr. Jessie B. Munoz appeared today before Manhattan Supreme Court Justice Jeffrey M. Atlas and pleaded guilty to Grand Larceny in the Fourth Degree in satisfaction of charges that had been pending against him since October. As part of his plea, Dr. Munoz also agreed to make restitution of $350,000 to the Medicaid program.

Sentencing was set for July 5th.

"Health care fraud is a problem that affects all Americans," said Spitzer. "It not only undermines public confidence in such government programs as Medicaid, which was designed to assist the needy, but robs these programs of sorely needed tax dollars. It is inexcusable for this provider, operating out of one of the most exclusive addresses in the country, to have billed for services that were never provided. Today's action sends a clear message that my office is committed to aggressively pursuing and prosecuting those individuals who steal from the taxpayers of this State."

Dr. Munoz operated the now defunct VIP Medical Associates, a diagnostic and treatment clinic located at 72 Fifth Avenue in Manhattan. The clinic was certified by the State Department of Health (DOH) to provide abortion and family planning services from its Fifth Avenue location. If a certified facility ceases operation, the provider is obligated to inform DOH within 90 days of the anticipated closing date.

Under Medicaid rules, clinic operators are allowed to bill for "threshold" visits - a rate of $34 for patients who receive just family planning consultation and $222 for those who obtain an abortion. Providers can bill for only one threshold visit per patient per day because family counseling is included in the abortion rate.

Between May 1994 and January 1999, Dr. Munoz submitted numerous reimbursement claims in which he charged Medicaid for two threshold visits - claiming both the abortion and family counseling rate - for each patient he saw on a given day.

In February 1999, when VIP Medical Associates lost its lease at 72 Fifth Avenue and closed down, Dr. Munoz continued to bill Medicaid for patients who were actually being seen by physicians at another clinic.

Dr. Munoz, 48, lives at 255 Trumbull Road in Manhasset, Long Island. He presently has a medical office at 40-25 74th Street in Jackson Heights, Queens.

Spitzer noted that his office has referred the case to DOH's Office of Professional Medical Conduct for a review of Dr. Munoz's medical license.

Special Assistant Attorney General Kiran Heer, of the New York City Regional Office of the Attorney General's Medicaid Fraud Control Unit, prosecuted the case. All cases are handled under the direct supervision of Deputy Attorney General Jos? Maldonado.