04/29/2014
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| Dr. Ralph Hansen |
They lied, stole and ultimately confessed to felonies committed to satisfy their drug addictions that in other states cost them the privilege of practicing medicine. The federal government even banned the two doctors from billing for Medicaid services because of their crimes.
But in New Mexico, Drs. Ralph Hansen and Keith Levitt have found welcoming homes and a revival of their careers. The state government, fully aware of the doctors’ pasts, gave them supervisory jobs with the agency that provides and oversees care of indigent patients.
The state also sought special waivers from the federal government to allow the doctors to bill for Medicaid services.
The state hired Hansen and Levitt as regional medical officers for the Department of Health, jobs that required them to treat patients and administer public health programs to financially fragile populations in multi-county swaths of the state.
Recruiting and keeping doctors in rural New Mexico is difficult, a challenge highlighted by the state’s hiring of Hansen and Levitt. Of New Mexico’s 33 counties, 32 are designated as health professional shortage areas by the U.S. Department of Health and Human Services.
“By any measure, the supply and distribution of New Mexico’s health care workforce is inadequate,” the New Mexico Health Policy Commission concluded in a 2011 report.
The New Mexico Human Services Department, which last summer suspended the contracts of 15 behavioral health firms across the state amid allegations of Medicaid fraud, successfully petitioned the federal government earlier this year for waivers that enabled Hansen and Levitt to seek Medicaid reimbursement. In its requests, the department said the waivers were necessary because Hansen and Levitt were the sole medical providers in the rural areas they serve, though Hansen’s area of responsibility also includes Albuquerque, the state’s most populous city.
According to the Department of Health, the waiver was sought for Hansen because he was the only supervising physician in public health for the region that included Albuquerque.
Currently, only 16 such exemptions involving 15 doctors are active across the United States, and four of them have been issued to New Mexico doctors. The only other state with more than one doctor practicing under a waiver is Montana, which has two.
The U.S. Department of Health and Human Services has no record of requests being denied for the Medicaid waivers, according to a statement provided toThe New Mexican by the Office of the Inspector General.
“The OIG would deny a waiver if it was determined that the issuance of a waiver would not be in the best interests of the Department’s programs or the beneficiaries that the programs serve,” the statement said.
When state health agencies submit requests stating that doctors with tainted histories are the sole providers available to serve a particular area, the federal government takes their word for it and does not do further investigation.
“These groups are considered credible sources in making the determination for the need in their areas,” the OIG statement said.
Three of the federal waivers in New Mexico were granted in 2013 and 2014 to Hansen and Levitt. The fourth was granted in 2009 to Union County Medical Center Inc. in Clayton, based on the community’s need for medical services. The center’s owner, Dr. Mark Van Wormer, had pleaded guilty in 2007 to injecting about 120 patients with what he said was Botox but was actually a substance not approved by the U.S. Food and Drug Administration. His medical license in New Mexico was revoked. Van Wormer’s center is not affiliated with the Union County General Hospital in Clayton.
Hansen, 62, had been practicing medicine in California for 25 years before he began recreational use of Ritalin, a stimulant typically prescribed to patients diagnosed with attention deficit disorder, according to documents from the Medical Board of California.
In June 2007, one month after he’d been fired by a medical group, Hansen was caught at a Torrance, Calif., pharmacy trying to fill a Ritalin prescription written for his deceased father-in-law. When questioned by police, Hansen confessed to stealing prescription pads from other physicians at his former medical group and writing prescriptions for himself or in the names of his relatives and fictitious patients, then picking up the drugs himself.
Investigators for the Medical Board of California determined that between 2004 and 2007, Hansen had filled more than 300 fraudulent prescriptions. He was charged in California District Court with 15 felony counts of burglary, forgery, possession of an illegal prescription and obtaining controlled substances by fraud. He pleaded no contest in November 2007 to one felony count of obtaining a controlled substance by fraud and received a five-year suspended prison sentence.
In 2009, before his suspended sentence was even complete, New Mexico hired Hansen as medical director at Central New Mexico Correctional Facility in Los Lunas and later in the same position at the Department of Health’s Developmental Disabilities Supports Division. Neither position required a federal waiver. The state obtained a waiver after it hired him in July 2013 as the regional health officer for the Albuquerque metro area and the state’s northwest region. The area covers Bernalillo, Cibola, McKinley, San Juan, Sandoval, Torrance and Valencia counties.
Hansen beat out one other applicant for the job. The Health Department would not identify the other candidate or provide specific details about what separated Hansen as the department’s top choice.
“I’m an open book,” Hansen said in a brief phone interview Friday. “I don’t have anything to hide.”
However, he said he could not submit to a full interview without permission from the Health Department and did not return further phone calls.
Levitt, 56, faced disciplinary actions against his license stemming from prescription drug abuse dating back to 1991 in Maryland, Arizona and Washington. The last was in early 2009, when he was stripped of his license to practice medicine in Washington after pleading guilty in October 2008 to a federal felony of acquiring a controlled substance by misrepresentation, deception and subterfuge and was placed on probation for three years.
Levitt had written prescriptions for the potent painkiller hydrocodone to another person, who filled the prescriptions and shared the pills with Levitt, according to U.S. Department of Justice reports. Additionally, after suspension of his Drug Enforcement Administration number, which is required to prescribe medications, he began to write prescriptions for hydrocodone for himself and others using the DEA numbers of his colleagues at a Seattle clinic.
The Department of Justice investigation into Levitt also snared a Seattle dentist; the two had teamed up to write hydrocodone prescriptions for each other.
Former patients told Seattle television station KOMO 4 in 2007 that Levitt, who was trained as an anesthesiologist, had represented himself to them as a dermatologist and had botched the cosmetic procedures he performed, requiring them to have more procedures. The patients also told the television station that they suspected Levitt was high on drugs when he treated them because his eyes were glossy and he had trouble focusing.
Levitt was hired by the New Mexico Department of Health in October 2012 as the regional health officer for the state’s southeastern region, spanning the rural counties of Chaves, Curry, DeBaca, Eddy, Lea, Lincoln, Roosevelt and Quay. No other applicants sought the job, according to Department of Health spokesman Kenny Vigil.
Levitt recently became Hansen’s assistant regional health officer, based in Gallup. Among the five regional health officer positions, only the southeast region post is vacant since Levitt left. Most of the health officers are paid between $130,000 and $135,000 per year, but Hansen makes about $180,000. Levitt earns about $135,000.
In a November 2012 letter to the U.S. Department of Health and Human Services Office of the Inspector General that seeks conditional reinstatement of Levitt’s ability to seek Medicaid reimbursement, Brad McGrath, Gov. Susana Martinez’s interim Cabinet secretary of the Department of Health, wrote: “Dr. Levitt would be the sole community physician and sole source of medical oversight of essential Public Health services in the community.”
Numerous attempts to contact Levitt last week were unsuccessful.
New Mexico has struggled to recruit and retain qualified physicians to provide care for patients in its public health programs in rural parts of the state, McGrath wrote in the letter.
The state’s safety net program provides clinical services such as family planning, screening for sexually transmitted diseases, breast and cervical cancer screenings, immunizations, low-risk prenatal care and other services. As regional health officers, Levitt and Hansen have overseen and given direction to these programs as well as school health systems, a program for children with special health care needs and the Supplemental Food for Women, Infants and Children program, known as WIC.
“Nearly all clients who receive clinical services in public health offices are low-income,” McGrath wrote in the letter to the federal government. Approximately 70 percent of them are uninsured and 20 percent of the patients are covered by Medicaid.
Although the job descriptions say a doctor in the positions held by Hansen and Levitt “diagnoses, treats and helps prevent diseases and injuries that commonly occur in the general public,” the duties they can perform are limited, in Levitt’s case because of his troubled past.
“[Levitt] has limited patient care contact for family planning, STD screenings and diagnosis and treatment of infectious diseases, such as [tuberculosis],” Vigil said. “He does not prescribe or dispense narcotics.”
Hansen mainly consults and oversees clinical providers in the region and does not have direct patient care contact, Vigil said.
Levitt first tried to obtain a New Mexico medical license in February 2011, a little more than one year after Washington state had revoked his license for five years. An evaluation by the New Mexico Monitored Treatment Program, which conducts drug testing and provides support to doctors with substance abuse problems, recommended rejection of Levitt’s application, and the New Mexico Medical Board agreed.
“ ‘Only with extreme caution’ could MTP recommend a person with Dr. Levitt’s history being in an environment where drugs were easily accessible,” the program evaluators wrote.
At the time, Levitt was working as a test-driver for Mercedes-Benz and managed a home for men coming out of drug treatment.
In August 2012, Levitt reapplied, and the New Mexico Medical Board granted him a license. Two months later, he was head of a regional office of the state Health Department. In the months between his first application for licensure in New Mexico and his second, Levitt completed continuing medical education programs and was successful in the state’s Monitored Treatment Program without relapse, according to Debbie Dieterich, investigations and compliance manager with the New Mexico Medical Board.
“The board’s mission is to aid in the rehabilitation of its licensees so they can safely practice medicine in our underserved state,” Dieterich said.
As conditions of their licenses, both Levitt and Hansen are subject to periodic drug tests. Any violation would constitute grounds for disciplinary action against their licenses. Both doctors have abided by the terms of their employment by avoiding drugs and alcohol, Dieterich said.
The federal exemptions granted to them only apply as long as they hold their current jobs, and only in the specified New Mexico counties.
New Mexico Human Services Department spokesman Matt Kennicott said the department’s role in getting the doctors’ federal billing privileges restored is not analogous to its actions that halted funding to New Mexico behavioral health providers and redirected those funds to Arizona firms.
“This is very different than committing Medicaid fraud and what the [behavioral health] agencies did,” Kennicott said.
James Kerlin, who spent 25 years as the chief executive officer of The Counseling Center of Alamogordo before it closed in the aftermath of the state’s action, disagrees. He contends the Human Services Department deprived behavioral health providers of livelihoods based on mere suspicion of fraud, but provided careers to doctors proven to have committed crimes.
“It surprises me that they had no trouble finding replacements for a fairly decent-sized group of organizations, but they couldn’t find alternatives to a couple of doctors. Come on, that seems a little far-fetched to me,” Kerlin said.
“If they’re concerned enough about the treatment the citizens are going to get to close 85 percent of the system’s behavioral health providers, they certainly should be concerned about doctors who have been found guilty in the past.”
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