A local pediatrician faces up to 54 years in prison if convicted on charges of defrauding Medicaid.

Dr. Gerald Slater, a 59-year-old retired pediatrician who lives in Glenwood Springs, stands accused of bilking Medicaid out of more than $60,000 by submitting fraudulent bills to the federal program that reimburses medical providers when they give medical assistance to the needy.

His case is set for trial in February.

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Slater was indicted March 7, 2003, by a Colorado grand jury on two charges of theft, two charges of computer crime and two charges of offering a false instrument for recording in the first degree ” all felonies.

According to the indictment, during 1997, 2000 and 2001, Slater treated 54 “neonates” ” a term that refers to babies from birth until they’re 30 days old ” at Valley View Hospital. All the parents of the 54 babies in question were eligible for Medicaid.

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Valley View Hospital officials did not return phone calls from the Post Independent seeking comment on the case.

All babies billed as critically ill

The indictment states that Slater billed Medicaid at the highest possible “code” for all 54 babies.

“A given code is assigned a monetary value based on the level of care and complexity of service associated with the code,” the indictment said. “Codes for lower levels of care and complexity pay much less than codes assigned to the care of critically ill neonates.”

Slater, the indictment said, billed for the babies at a code that would only be used if the babies were in extremely critical condition.

The indictment goes on to state, “A review of the charts by a neonatologist found that 53 of the 54 neonates were not critically ill and should have been billed at a much lower level. The one neonate that qualified as critical in the review was critical for a much shorter period than the period billed by Dr. Slater.”

In all, the indictment states that Medicaid should have reimbursed Slater $7,482 for his work in 1997 and $8,425 for work in 2000 and 2001.

But during those periods, the doctor allegedly billed Medicaid for just over $80,000 ” $64,400 of which was fraudulent.

Slater offered a statement Saturday through his attorney, Gary Lozow of Denver:

“What is most important to me is good medical care for my patients. I’ve always tried to be a doctor who emphasized the care of my patients.

“The issues surrounding my good-faith beliefs about billing practices for committed professional treatment is what a jury will have to decide. I am a physician, not a billing specialist.”

Slater’s trial is scheduled to start Feb. 23, 2004, at the Garfield County Courthouse and could last more than a week.

If convicted, the doctor could face 18 to 54 years in state prison for the six felony counts.

Former D.A. investigated charges

The allegations were investigated by the office of former 9th District Attorney Milt Blakey, who now serves as director of the Colorado Medicaid Fraud Control Unit at the Colorado Attorney General’s Office in Denver.

Blakey assigned special prosecutor Mark Zammuto, also from the Colorado Medicaid Fraud Control Unit, to prosecute the case in the 9th Judicial District.

Blakey, who served as D.A. in Garfield County from 1981 to 1996, moved to the Front Range in 1997 to become the unit’s director. Blakey said it’s his office’s policy not to speak specifically about pending cases, but he gave some background on his investigative unit.

“That’s all we deal with is Medicaid fraud,” he said. “And only fraud committed by providers.”

The unit investigates around 60 cases a year, pressing charges in just 10 or 12 a year.

He said the problem of Medicaid fraud is nationwide, and widespread.

“That’s why these Medicaid fraud units exist,” he said, “so any kind of fraud on the program, or in the program, will be investigated.”

Medicaid, which is a program that helps needy people pay for medical care, has a finite amount of money, Blakey said, so it’s important to let medical providers know someone’s watching.

The number of medical providers who are reimbursed by Medicaid is staggering. In Colorado alone during the 2003 fiscal year there were a total of 44,989 enrolled providers and 315,354 recipients.

Overcharges first discovered at Valley View Hospital

Blakey said to win a conviction, the fraud unit must prove that a suspect had the intent to defraud the system.

And rather than using the dollar amount of a suspected fraud to decide which cases to investigate, Blakey said, “We look at conduct.”

According to the indictment, Slater first came to the fraud unit’s attention in September 2000, “when he was investigated for billing practices associated with his private office practice.”

“It was discovered that Dr. Slater was billing at a high rate for his services at Valley View Hospital,” the indictment said.

A peer review within the hospital confirmed that the doctor “was billing for infants in the hospital at a higher level than was justified,” the indictment said.

In February 2001, the case was re-referred to the Medicaid Fraud Control Unit for investigation of the critical care coding violations.

“It’s a very serious problem when money is misappropriated,” Blakey said. “That’s why the Medicare fraud unit sees its priority as keeping honest providers honest.”

Contact Greg Masse: 945-8515, ext. 511

gmasse@postindependent.com