Department of Health
Inappropriate Payments for Vision Care Services Claimed by Dr. Horowitz We audited about $370,000 in Medicaid claims submitted by Dr. Horowitz, an optometrist on Staten Island, because our ongoing analysis of Medicaid records indicated that the claims could be questionable. For example, the usual frequency for optometric examinations is once every 24 months. However, Dr. Horowitz routinely billed Medicaid more frequently for his patients, sometimes claiming he provided the patients with ten or more eye examinations in a 24-month period. When we reviewed Dr. Horowitz’s medical records for these patients, we found no indication the patients needed to be examined so frequently.
Our review of the patients’ medical records also showed that Dr. Horowitz may have billed Medicaid for services that were not medically necessary and might not have been performed. We further determined that Dr. Horowitz routinely overbilled Medicaid when the patients were also eligible for Medicare, and routinely overbilled for the cost of his transportation to the nursing home where most of his patients lived. We concluded that about $239,500 of the $370,000 in Medicaid payments (65 percent) received by Dr. Horowitz during our five-year audit period may have been inappropriate. We recommended that the Department of Health investigate these payments and make all appropriate recoveries. In addition, we referred Dr. Horowitz to the Office of the Medicaid Inspector General for further investigation.
For a complete copy of Report 2008-S-166 click here.
For a copy of the associated follow-up report click here.