This is an archived article that was published on sltrib.com in 2010, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
A West Valley City women's clinic that recently closed after an employee was arrested for unlawfully practicing medicine is now suspected of defrauding Medicaid of more than $1 million.
During the past five years, Westview Women's Center and an affiliated billing center, All Medical Billing Inc., coached thousands of low-income women on how to use fake Social Security numbers and other fabricated information to apply for Baby Your Baby, a prenatal program funded by Medicaid, authorities allege.
The clinic then billed the program for care that wasn't medically necessary, according to court documents unsealed on Wednesday.
No criminal charges have been filed.
"This is an ongoing investigation," said Robert Steed, director of the Utah Medicaid Fraud Unit of the Attorney General's Office, describing the probe as "larger in scale" than is typical.
The clinic's owners and managers are Goldie Dennison, LaRhonda Dennison and Cydore Dennison, according to a 69-page affidavit filed in 3rd District Court to request a warrant to search the clinic. The search was executed on Aug. 18, the same day clinic employee Jose "Jesus" Sanchez was arrested for performing ultrasound screenings without a license.
He was booked into jail and released on bail. His next court appearance is Oct. 12.
He is a Mexican national, and clinic staff believed he had worked there as a physician, according to court documents, but he isn't licensed to practice in Utah. He came to the United States on a work visa and was hired by Westview on Jan. 1, 2006, where he remained despite concerns raised by other clinic staff about the quality of his care.
Sanchez, 56, performed ultrasounds too early in pregnancies, delivering images of poor quality that had no medical value, said P.T. Nguyen, a West Valley City doctor quoted in the search warrant affidavit. Nguyen, who no longer works at Westview, told investigators about a patient who gave birth to a child with serious facial deformities – a missing eye and a cleft palate — that should have been detected by ultrasound.
When he complained, Nguyen said, he received a memo from clinic Director LaRhonda Dennison ordering that all ultrasounds be performed by Sanchez.
Matthew Agresta, a family practitioner who did pediatric care at Westview but no longer works there, told investigators there was pressure to bill for services while patients were enrolled in Baby Your Baby. The prenatal coverage lasts up to two months and is intended as a temporary bridge for women applying to enroll in Medicaid.
Calls to Sanchez and Nguyen weren't returned. Agresta declined to comment.
Westview routinely billed Baby Your Baby for more ultrasounds than any other clinic in Utah, according to claims specialists at the Utah Health Department who first tipped authorities to a potential problem in November 2009.
Health officials were reviewing claims data and noticed that Westview filed a high number of Baby Your Baby claims, but only a small percentage of those patients ever became eligible for Medicaid.
That's unusual, "because it is presumed that a patient who qualifies for Baby Your Baby should also qualify for traditional Medicaid," the affidavit stated. The clinic's patients later surfaced on Medicaid's books, however, when their deliveries were paid for by a special program that covers only emergency care for noncitizens.
Evidence gathered from clinic staff indicated that patients were handed contracts directing them to apply for Baby Your Baby by claiming they were legal residents, then later obtain emergency Medicaid by declaring their nonlegal resident status, the affidavit said.
The contracts further instructed patients to deliver their babies at Jordan Valley Medical Center in West Jordan and warned they would face a penalty of $1,200 if they delivered elsewhere or changed clinics.
IASIS Health Care, Inc., the hospital's owner, had no knowledge of the contract or control over it, said an IASIS spokeswoman Jonie Brady.
According to the Department of Health, Medicaid patients are free to choose any Medicaid-endorsed provider or hospital. And Utah law forbids charging Medicaid patients for care covered by Medicaid.
An undercover officer sought care at the clinic in May and was given one of the contracts, the affidavit said.
Mary Ayala estimates she began complaining about Westview's billing in 2004. As a financial coordinator for Baby Your Baby through a separate company — the Exodus Health Care Network — Ayala met several Westview patients who came to her office to apply for the program.
She told The Salt Lake Tribune that she suspected a problem when the patients didn't know their Social Security numbers.
"I'd ask for their Social Security number, and they would pull out a little piece of paper," said Ayala, who complained to the Baby Your Baby office of Medicaid but was told it wasn't Baby Your Baby's job to question the women's legal status.
Deborah Michaelson, a registered nurse at Westview in 2005, told The Tribune she watched an officeworker there teach patients to lie about their immigration status. The woman would ask the patients if they had a Social Security number, Michaelson said. When patients said no, the woman would respond, "That's OK, just give me nine numbers from the top of your head," Michaelson said.
Michaelson, who was expected to sign off on Westview's Baby Your Baby applications, refused to do so and left. She returned in 2007 when she was told that practices had changed. But she says they hadn't, and she soon quit again.
Ayala doesn't blame the patients.
"Not being from this country, they were taught to work the system instead of doing things legally," she said.
About Baby Your Baby
What is it? • Baby Your Baby is a part of Medicaid, health coverage funded by the state and federal government for low-income residents.
What it covers • It temporarily pays for prenatal care for women presumed to be eligible for Medicaid, aiming to prevent needy, expectant mothers from forgoing critical prenatal care. It has been proven to reduce birth defects and other complications with delivery.
How women qualify • Mothers must be U.S. citizens or legal residents of Utah for at least five years, but no proof of citizenship is required. Under a streamlined application process completed online or by phone, women only attest to their citizenship status, income and other information.
How long it lasts • Baby Your Baby benefits last two months, at most, because it is meant as a stopgap until women complete the lengthier process of enrolling in Medicaid.