Managed Care Provider Pleads Guilty To $275,000 Medicaid Fraud

Attorney General Spitzer today announced that a physician's assistant who operated two medical clinics in the Bedford-Stuyvesant section of Brooklyn has admitted to stealing more than $275,000 from taxpayers through the Medicaid program. The clinics, which were subcontracted by an HMO doing business with the city to provide health care services to approximately 1,600 Medicaid recipients, were inadequately staffed and patients often did not have access to proper medical care.

Appearing yesterday in Manhattan Supreme Court before Justice Renee A. White, Jean Moise Millien and his corporation, Stuyvesant Heights Medical Group, P.C., pleaded guilty to Grand Larceny in the Second Degree.

In court, Millien admitted that physicians at his clinics did not see patients, physician's assistants were unsupervised, and that he took money out of the payroll account before employees could get paid.

Sentencing was set for February 27, at which time Justice White indicated she would sentence Millien to one to three years in prison, and fine the corporation $10,000. As part of his plea, Millien will make restitution of $275,000 to the Medicaid program.

Attorney General Spitzer said, "This was a landmark investigation by my office. For the first time, we took a comprehensive look at both an HMO and its subcontractor. We found that many patients were unable to access medical care, and those who did were often being treated by medical personnel other than doctors - in violation of the city's contract, and in violation of the subcontract that the HMO had with Stuyvesant Heights. In addition, we'll get restitution for taxpayers."

Spitzer continued, "This investigation and prosecution by my Medicaid Fraud Control Unit (MFCU) drives home our message: If you are stealing from State taxpayers, we will find you and prosecute you to the fullest extent of the law."

In March 1995, Managed Healthcare Systems of New York, Inc. (MHS), a Manhattan-based health maintenance organization under contract with the City of New York to provide health care to Medicaid recipients, contracted with Stuyvesant Heights through its operator, Millien, to provide primary care physicians to recipients at two Brooklyn locations: 2106 Linden Boulevard and 1155 Broadway. Under the contract, Stuyvesant Heights physicians were required to be available to patients twenty hours a week, and the clinics were to provide 24-hour coverage.

However, soon thereafter, MHS became aware that medical services at Stuyvesant Heights were largely being provided by unsupervised physician's assistants or nurse practitioners; that patients were consistently complaining that they were having difficulty getting services or being seen by a doctor; and that patients were being seen at unauthorized Stuyvesant Heights locations in Brooklyn. Despite this information, MHS failed to take any corrective action or properly oversee Stuyvesant Heights.

Spitzer noted that, in June, MHS repaid more than $2 million, including interest, to the Medicaid program for services that the State funded but recipients never received at Stuyvesant Heights clinics.

The settlement was based on a MFCU investigation that included an audit of MHS's records, as well as interviews of MHS/Stuyvesant Heights employees and Medicaid recipients. In reviewing MHS's Medicaid billing records, the audit revealed that, between February 1995, and April 1997, MHS received $1,723,807 in Medicaid reimbursement for services that Stuyvesant Heights never provided.

For example, patients complained that they had taken their children for immunizations at Stuyvesant Heights but were turned away because the clinic had no vaccines or syringes.

In another instance, a doctor who supervised physician's assistants at Stuyvesant Heights' 1155 Broadway clinic moved to Pennsylvania in 1995 where he had a surgical practice. Initially, he would come to Brooklyn once a week to sign medical charts. Thereafter, he came less and less often until eventually his visits to the clinic stopped altogether, leaving patients in the hands of unsupervised clinic assistants.

Millien, 38, lives at 89-22 215th Street in Queens Village, Queens. He has been held on Rikers Island on $250,000 bail since his arrest in July. In November, the State Health Department revoked Millien's physician's assistant license and fined him $130,000 for among other things, obtaining his license fraudulently, gross negligence, gross incompetence, filing false reports, and ordering excessive tests and/or treatment not warranted by the patient's condition.

Managed Healthcare Systems of New York, Inc., New York's largest managed Medicaid plan, is located at 7 Hanover Square in Manhattan. In November, MHS changed its name to AmeriChoice of New York. The company is owned by AmeriChoice Corp., a privately held company in Vienna, Virginia.

The case was prosecuted by Special Assistant Attorney General Mark Moskovitz, Deputy Director of the New York City Regional Office of Spitzer's Medicaid Fraud Control Unit. All cases are handled under the direct supervision of Deputy Attorney General Jos? Maldonado.