Dr. Clarence Edwards, the highest-earning doctor in the District's Medicaid program, has been accused by a physicians' review group of a "gross" over use of tests for his indigent patients.
According to the confidential report, a copy of which was obtained by The Washington Post, Edwards orders too many sickle cell anemia tests, blood and urine tests and sonograms -- a procedure that uses sound waves to make a picture of internal organs.
Peter Coppola, chief of the District's Medicaid program, said the city will try to force Edwards to pay back the government for payments he has received for any unnecessary tests performed in the last three years.
During that period, Edwards has received $1,019,000 in city and federal funds for treating patients in his Northeast Washington obstetrics and gynecology practice.
While Coppola said he does not know how much money is at issue, at $35 a sonogram and smaller amounts for the other tests at issue, the total can only be a small proportion of Edwards' Medicaid earnings.
According to the report, Edwards billed Medicaid for 2,343 sonograms in 1978 for 1,406 patients, and 1,022 sickle cell tests on 892 patients.
The report, prepared for the D.C. Medicaid program, has been forwarded to the U.S. Health Education and Welfare Department's "project integrity" -- a program designed to eliminate abuse in the Medicaid program -- for possible action.
Edwards said that not only are all the tests he performs called for, he is actually saving Medicaid money by using the tests to keep his patients out of the hospital.
"My office is not located near downtown," said Edwards, a highly trained specialist with a good reputation in his field. "It's not located near any laboratory. We act as (our patients') primary physician. We hospitalize a lower percentage of patients than any other office in the inner city and maybe the entire city.
"They're not accusing us of treating patients improperly; they say we don't want you to do as much as you're doing for these patients."
The physicians who conducted the survey for the National Capital Medical Foundation -- the Federally chartered peer review agency for the District -- would not comment on the case because they all signed an oath not to discuss it.
According to the report, Edwards used the sonography machine in his office to test 76 percent of his patients an average of 2.2 times.
The report then states that the "obstetrician/gynecologist with the next highest frequency of sonograms . . . submitted claims for . . . only 38 percent of his/her patients," and with an average of 1.1 sonograms per patient.
After reviewing all of Edwards' Medicaid billings, the peer review group examined the complete files of 10 patients and said they "confirmed this gross overutilization. In the five obstetrical cases reviewed, all five patients had at least four sonograms and one had 13. All of the non-obstetrical patients selected for review had at least one sonogram and one had five . ."