Top Prescribers Propped Up By Tax Dollars
By Ken Kramer
September 6, 2013
(Note: “Medicaid” and “Medicare” are both defined at end of this article)In 2010, a Florida whistleblower informed investigators in U.S. Senator Grassley’s office about the massive psych drug prescribing of Fernando Mendez-Villamil. He wrote $43 million worth of prescriptions in a 6 year period – about 153 prescriptions every day, paid for by Medicaid – your tax dollars.
Grassley promptly started investigating with letters to federal officials asking them if they were watching over top prescribers such as Mendez-Villamil.
In 2010, Grassley then asked each state to provide him with a list of the top Medicaid* prescribers for 2008 and 2009 of various antipsychotic drugs, an “anti-anxiety” drug and several pain killers. Each state provided these lists to Grassley.
PsychSearch then contacted each state and scooped up all the records they gave Grassley.
In 2012, Senator Grassley duplicated his request for top prescribers for 2010 and 2011.
PsychSearch then scooped up those records.
So now, PsychSearch has a compilation of practically every state’s top prescribers for the 4-year period 2008 – 2011 which you can find here: https://www.psychsearch.net/top-prescribers/
Imagine that – the top Medicaid prescribers of psychiatric drugs for the entire country are now known! An invaluable tool for those investigating psychiatrists!
Many newspaper articles were published exposing the top prescribers across the country.
How many of these top prescribers have since been terminated from Medicaid and how many millions in tax dollars are now not going to these top prescribers?
That is unknown. But we are about to find out. It’s a simple matter of comparing the list of top prescribers gathered with those who have been terminated from Medicaid.
Example, Mendez-Villamil was terminated from Florida Medicaid. Now Medicaid pays zero for his prescriptions.
But wait! Astonishment! Mendez-Villaml is not listed when we searched the Fed’s Medicare** terminations here: http://exclusions.oig.hhs.gov/
On June 19, we asked an “Investigations Analyst” which oversees these Federal Medicare exclusions, why Mendez-Villamil could not be found. The response on June 20 was “We are investigating and will get back to you.” Still waiting, but perhaps today we get the answer as this Analyst was informed to put it in writing after she requested a phone conversation yesterday.
According to Propublica, Mendez-Villamil is still prescribing under Medicare! He wrote $3.1 million worth of Medicare prescriptions in 2010. Propublica says “Working primarily out of his walk-in clinic, he wrote 6,100 prescriptions for antipsychotics in 2009 and 5,500 more in 2010”.
Apparently there is a disconnect between State Medicaid programs and the Feds Medicare! State Medicaid terminated psychiatrists apparently are not being reported as they should, up and down the line, to the Feds so they can then determine whether a termination from Medicare is warranted!
On June 24, Senator Grassley sent letters to each state, questioning each state’s Medicaid officials about how they handle Medicaid terminations and if they report these to the federal government. The Senator told them:
“When our government allows doctors who have been criminally convicted for problem prescribing practices and even terminated under state Medicaid programs to provide services under Medicare, it exposes the elderly and chronically ill to potentially unsafe medical treatment and wastes millions of taxpayer dollars on fraudulent, abusive, and unreliable providers.”
Medicare is the largest federal healthcare program in the country, providing benefits to more than 40 million Americans and carrying a price tag of over $550 billion. Over 4,000 hospitals and 600,000 individuals provide health care services to Medicare enrollees. Many of these providers also deliver services under State Medicaid programs.
By statute, Medicare must terminate any individual physician or entity from its
rolls if that provider was terminated under any State’s Medicaid program.”
And yes, you may have quessed – we have scooped up all the state’s responses to the Senator.
Now, since we were already going to find out how many top prescribing psychiatrists were terminated from State Medicaid programs, we have added another step to this plan:
Report all the State Medicaid terminated psychiatrists to the Feds!
Perhaps then we can assist in cutting their Medicare funding too!
*Medicaid is a joint federal and state program that helps low-income individuals and families pay for the costs associated with medical and long-term custodial care. The federal government funds up to 50% of the cost of each state’s Medicaid program
**Medicare is a federal program available to all U.S. citizens 65 years of age or older and it also covers people with certain disabilities.