WEST VALLEY — Prosecutors are investigating a West Valley women's clinic they say submitted more than $1 million in false Medicaid claims.
Westview Women's Clinic and its associated medical billing company, All Medical Billing, have allegedly been enrolling their patients in a program called Baby Your Baby unlawfully for at least five years.
According to a search warrant filed in 3rd District court, the director of the clinic had been "coaching" prospective clients on how to fraudulently apply for Baby Your Baby services, including providing them with Social Security numbers and telling them to say they were citizens of the U.S. when they were not.
The program is intended for use by U.S. citizens who are pregnant and are awaiting approval of Medicaid.
The affidavit states that an usually high number of Westview patients did not become eligible for Medicaid and applied for Emergency Medicaid near delivery. That program is reserved for illegal immigrants in emergency situations.
"It is apparent that a high number of Westview's patients are obtaining BYB services by attesting that they were legal residents of the United States and then subsequently obtaining Emergency Medicaid Coverage by declaring their non-legal status," the affidavit states.
Wendy Ramirez, who makes eligibility determinations for BYB applicants, said in the affidavit that patients had admitted to being coached on what to say to her and that she frequently saw patients who had Social Security numbers written on post-it notes.
Deborah Michaelson was employed at Westview in 2005 but became uncomfortable with the procedures there and was terminated, according to the affidavit. She then was rehired in 2007 because she believed their practices had changed, but she indicated to investigators that they hadn't.
Michaelson told investigators that she had overheard the clinic director asking patients to come up with a nine-digit number in their head as their Social Security number and that when she complained to an owner and manager of the clinic about billing issues, she was told, "We have done this for years. Do it our way or leave."
Investigators also discovered that the clinic billed Medicaid for the highest number of early-stage ultrasounds in the state, the affidavit states. In 2009, the document states, the clinic ordered twice as many early ultrasounds as the other top-billing clinics and practitioners in Utah combined.
Physicians interviewed were concerned that many of the ultrasounds had no medical value, the affidavit states.
"It is apparent from documents and interviews that Medicaid is the primary source of revenue for the clinic and the majority of the prenatal care delivered at the clinic involves possible fraud or other criminal violations," prosecutors wrote in the affidavit.
A couple of months ago, a clinic director there was charged with unlawful practice of medicine, a third-degree felony.
Jose de Jesus Cruz Sanchez, 53, performed and interpreted ultrasounds and other radiology studies and exams," according to court documents.
One of his patients delivered a baby with "serious facial deformities, including a missing eye and double cleft palates" which was not detected by an ultrasound but should have been, according to the affidavit.
Another patient also had a large mass on her ovary, which was not detected by Sanchez but should have been, the court document stated.
Sanchez is reportedly a licensed radiologist in Mexico.
Robert E. Steed, director of Utah Medicaid fraud, who reviewed the affidavit, said the investigation has been ongoing since November 2009.
"I think one of the things that we would want to make very importantly clear is that this investigation was never initiated to target illegal immigration," Steed said. "We weren't looking at that issue. It was based on specific references from individuals who reported information to the Department of Health."
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