Fifth Avenue Doctor Arrested In $50,000+ Medicaid Scam
Attorney General Spitzer today announced that a Manhattan physician who formerly ran a Fifth Avenue abortion clinic has been arrested for stealing more than $50,000 by double billing taxpayers for patient visits, and billing for patients treated by other physicians.
Dr. Jessie B. Munoz, 48, of Manhasset, will be arraigned later today in Manhattan Supreme Court on an 11-count indictment. He is charged with one count of Grand Larceny in the Second Degree, one count of Attempted Grand Larceny in the Second Degree, and nine counts of Offering a False Instrument for Filing in the First Degree. If convicted, he faces up to 15 years in prison.
"The taxpayer-funded Medicaid system was designed to assist citizens in need, and my Office will continue to aggressively pursue and prosecute those individuals who steal from the taxpayers of this State," said Attorney General Spitzer.
Dr. Munoz operated the now-defunct VIP Medical Associates, a diagnostic and treatment clinic 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.
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 only one threshold visit per patient per day because family counseling is included in the abortion rate.
Between May 1994 and January 1999, it is alleged that 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.
It is further alleged that in February 1999, when VIP Medical Associates lost its lease and closed down, Dr. Munoz continued to bill Medicaid for patients who were being seen by physicians at another clinic. If a certified facility ceases operation, the provider is obligated to inform DOH within 90 days of the anticipated closing date.
Dr. Munoz lives at 255 Trumbull Road in Manhasset, Long Island. He presently has a medical office at 40-25 74th Street in Jackson Heights, Queens.
The Attorney General thanked the Health Department for referring the matter to his office.
Special Assistant Attorney General Kiran Heer, of the New York City Regional Office of the Attorney General's Medicaid Fraud Control Unit, is prosecuting the case. All cases are handled under the direct supervision of Deputy Attorney General Jos? Maldonado.
The charges against Dr. Munoz are accusations, and the defendant is presumed innocent until proven guilty.