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Dentist's troubles put state in a bind
By CANDACE RONDEAUX, Times Staff Writer ST. PETERSBURG -- When Debbie Stone brought her 16-year-old son, Joshua, to see Dr. Allena Burge three weeks ago, she was at her wits' end. The last time Stone had been to Burge's oral surgery practice on Central Avenue she watched her older son, Jacob, carried out the back door by two nurses. "He was covered in blood," Stone said. But Joshua needed dental care. "I was so scared to bring Josh there, but there's no other alternative," said Stone, a 40-year-old single mother and teaching assistant. "I called Medicaid and told them I wanted to go to a different doctor, but they told me there's no choice." Burge, who was arrested last month on Medicaid fraud charges, is Pinellas County's busiest oral surgeon who accepts Medicaid clients. She is also one of two oral surgeons who holds a contract with Pinellas County to provide health care to the poor through the county Department of Social Services. But now, with complaints about Burge continuing to mount, state officials have a dilemma: If they punish her, they are threatening dental care for hundreds of people. Since October 2001, her office has provided care to 4,425 Medicaid patients, state officials said. Kim Reed, spokesperson for the Agency for Health Care Administration, said that the limited number of dentists and oral surgeons who accept Medicaid patients makes it difficult for AHCA to discipline a provider who has overbilled or filed fraudulent claims. "It may be something that we consider when we think about looking at monitoring a dentist or an oral surgeon. Did we want to put something in place where we can monitor what a provider is doing or do we want to terminate their license and just not serve the population at all? It's a tough choice," Reed said. Burge was arrested on June 28 and charged with billing Medicaid for 3,331 false claims between 1998 and 2002. The charges say she fraudulently claimed $163,721. The St. Petersburg Times reported Monday that investigators have received dozens of complaints that Burge mistreated patients. Her former patients and employees say she was trying to bill Medicaid for as much as $12,000 a day; in one instance, her son administered anesthetic, according to state investigators. Burge has pleaded not guilty to the charges. Her attorney could not be reached for comment Monday. AHCA, which monitors Medicaid for the state, is reviewing each of Burge's insurance claims since her arrest. And Pinellas County's social services officials are continuing to do business with her but are monitoring her case, said Cliff Smith, assistant director of the Department of Social Services. Burge is one of six active oral surgeons serving the county under Medicaid, said Reed, the AHCA spokesperson, but only half of those provided service to more than one or two patients in the past year. "There are not a lot of oral surgeons out there who want to deal with the bureaucracy of providing to Medicaid patients. There are challenges out there to actually get people to come in to sign up to provide these services because of the low fees for reimbursement," Reed said. This is the second time AHCA has reviewed Burge's billing practices in the past four years. In 1998, auditors discovered that she filed more than $105,000 in fraudulent claims between 1996 and 1997. She was ordered to repay the money but didn't lose her authority to bill through the Medicaid program. Lack of oversight at AHCA is not all that uncommon, according to a September 2001 report written by the state's Office of Program Policy Analysis and Government Accountability. Although AHCA has the authority to impose up to a $5,000 fine on Medicaid providers who overbill or defraud the agency, the report said AHCA "rarely sanctions providers." The agency imposed fines on a little more than 1 percent of providers who overbilled Medicaid for false or errant claims between 1999 and 2000. It's costing taxpayers billions. Medicaid fraud and abuse in Florida cost taxpayers an estimated $2.1-billion to $4.3-billion between 1995 and 2001, according to the 2001 report. In all, the state's Medicaid Fraud Control Unit was only able to recover $96.7-million, or roughly 2 to 4.5 percent of those funds, in a six-year period. Yvonne Bigos, an analyst who contributed to the state's report on AHCA, said the agency should have disciplined Burge the first time they found billing irregularities. "She was not asked to pay any kind of fine. It's important in order to deter abusive behavior to sanction providers. It's important to do more than just asking for the money back," Bigos said. Reed, the AHCA spokesperson, said that while the agency has chosen not to revoke Burge's Medicaid license at this time, the agency "would consider that possibility in the future." Despite sworn statements from dozens of Burge's patients who complained about Burge's practices, Burge's state dental license remained active Monday.
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