Friday, March 10, 2006 - 12:00 AM


U.S. senator wants to know why Medicaid funded sex operations
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By Alicia Mundy
Seattle Times Washington bureau

WASHINGTON — The head of the Senate Finance Committee wants Gov. Christine Gregoire to explain why the state's Medicaid system is paying for erectile implants, sex-change operations and breast enlargements.

Sen. Charles Grassley, R-Iowa, said, in a letter sent Thursday to Gregoire, that he has asked the inspector general of the U.S. Department of Health and Human Services to look at what he considers dubious expenses discovered in the state's 2004 audit.

Grassley, who led the charge in Congress against Medicaid payments for Viagra and other erectile-dysfunction drugs, said his staff members have interviewed Washington's auditor about issues the auditor raised in the 2004 audit.

"I am amazed by the state auditor's findings," Grassley wrote, citing $9,500 spent for gender-transformation surgery for a Medicaid patient; $40,000 on plastic surgery; and more than $100,000 on "unauthorized" breast implants.

However, the state Department of Social and Health Services has disputed some of the auditor's 2004 findings, said state Medicaid director Doug Porter. He noted that no gender-change surgery has been approved since 2001.

Almost all of the patients approved for penile implants were suffering from prostate cancer, and breast-augmentation operations were approved for women who had suffered breast cancer, he said.

"We are not turning Medicaid clients into supermodels," Porter said.

He did note that the agency and the auditor have had a "rocky relationship."

State Auditor Brian Sonntag said Grassley's staff called him in February shortly after news stories about controversial items he had challenged during the audit.

"It was our office's first time to be contacted by a member of Congress," Sonntag said. "I did appreciate the fact that someone cared."

The 2005 audit will include new questions about spending, Sonntag said. He declined to name those before the audit is released next week.

Federal spending for sex changes and sexual-performance enhancements are the kind of hot-button items that provoke ire in the Congress.

In October, Grassley led a Senate vote to prohibit Medicare and Medicaid from footing the bill for Viagra and other erectile-dysfunction drugs starting this year.

Now, Grassley's staff wants to know how costs for more invasive procedures such as penile implants had been justified by DSHS, which oversees Medicaid payments to doctors and hospitals.

Sonntag has also complained publicly that his investigations were stymied by a lack of documentation from DSHS showing that the procedures were medically required and formally approved — a concern Grassley echoed.

"I am troubled by the [state] Department of Social and Health Service's alleged resistance to requests from the State Auditor's Office for access to records to determine if Medicaid funds were misspent," Grassley wrote.

However, Sonntag said his interactions with DSHS have vastly improved in the last year.

He also noted Washington was not the only state billing Medicaid for sexual-performance surgeries and gender transplants.

Gregoire did not comment on Grassley's letter, which she had not seen as of Thursday afternoon.

Alicia Mundy: 202-662-7457 or amundy@seattletimes.com