Gross Reciepts Of Odessa Allergy Clinic

Gross receipts for the OAC for the period 1998-2003

Dr. Rana frequently argued, in his own defense, that the amount of the billing errors was only a fraction of the total receipts for the Clinic. We have the yearly gross receipts for the Clinic for 1998 through 2003, and the yearly gross receipts for Medicaid for the y through 2001. 95004 billings as percentage of Gross Receipts

The Gross Amount Billed comes from G1 and G20. The data for Expected Profit and Real Profit from the 95004 procedure billing the Audit of Medicaid Billings on G1 and G20. We focus on the 95004 billings because that is the Government's accusation, that D a scheme to defraud Medicaid by over billing children under the age of two years for the 95004 procedure. Therefore, we need to s percentage of the Clinic's gross income is represented by these billings.

Gross Clinic Receipts1

1998

1999

2000

2001

2002

2003

$892,588.00

$786,290.00

$6,835.00

11,500.00

$871,871.00 11,600.00

$828,321.00 $10,790.00

$916,646.44 $13,680.00

$524,937.13 $25,380.00

0.8%

1.5%

1.3%

1.3%

1.5%

4.8%

$1,948.60

$2,274.72

$1,803.20

$1,865.84

$141.96

$0.00

0.2%

0.3%

0.2%

0.2%

0.0%

0.0%

$1,690.36

$1,112.64

$915.84

$1,734.80

($1,823.64)

($3,262.19)

0.2%

0.1%

0.1%

0.2%

0.0%

0.0%

Gross 95004 Billings % GB/GR Expected Profit/95004 % EP/GR Real Profit/95004 % RP/GR

$

1

Gross receipts, not gross billings. We do not yet have the gross billings.

The percentage of gross billings to gross clinic receipts jumps markedly in 2003 for two reasons. First, the Clinic increased its char 95004 procedure, raising the charge for 96 units from $480 to $720, and the charge for 48 units from $240 to $360. Medicaid paym procedure, however, did not change. Second, most of the 2003 patients on G20 had multiple billings for the same service because o of non-payment, resulting in claims being submitted a second and third time. The negative Profit for this year calls attention to how 2003 Medicaid claims, although entirely legitimate and correctly billed, were left unpaid. 95004 Billings as a percentage of Gross Medicaid Receipts

Gross Medicaid Receipts Gross Billings % GB/GMR Expected Profit/95004 %EP/GMR Real Profit/95004 % RP/GMR

1998

1999

2000

2001

TOTAL

$58,716.00

$98,924.00 11,500.00

$89,213.00 11,600.00

$127,833.00 $10,790.00

$374,686.00

$6,835.00 11.6%

11.6%

13.0%

8.4%

10.9%

$1,948.60

$2,274.72

$1,803.20

$1,865.84

$7,892.36

3.3%

2.3%

2.0%

1.5%

2.1%

$1,690.36

$1,112.64

$915.84

$1,734.80

$367.81

2.9%

1.1%

1.0%

1.4%

0.1%

$40,725.00