The Miami Herald
By: JOHN DORSCHNER
Medicare has stopped paying claims to Miami psychiatrist Fernando Mendez-Villamil because of questions over how he could prescribe mental health drugs at a rate of 150 a day, seven days a week, for a 21-month period.
“While the state is investigating, we haven’t paid his claims,” Medicare spokesman Peter Ashkenaz said Thursday.
Tiffany Vause, press secretary for the Florida Agency for Health Care Administration, said Mendez-Villamil is “under investigation so we can’t comment further.”
The Associated Press reported that the investigation began in 2007, triggered by a request from a private citizen.
Mendez-Villamil was the subject of a blistering letter released Wednesday by the office of Sen. CharlesGrassley, R-Iowa, asking Medicare and Medicaid officials if they had any programs in place to flag over-utilization, noting that a Florida provider had written 96,685 prescriptions over a 21-month period.
State records indicate that the provider is Mendez-Villamil.
The psychiatrist told The Miami Herald on Wednesday that he prescribes only what is medically necessary. He said he works long hours, seeing patients for 10 minutes at a time and many of his patients need four or five medications.
Medicaid is a state-administered program for the poor. Medicare is a federally administered program for the elderly and disabled.
The Grassley letter concerned the state program, without mentioning Medicare. It’s not clear how many Medicare prescriptions Mendez-Villamil writes. Medicare stopped paying his claims in May.
Some months ago, The Miami Herald asked Florida Medicaid officials if Mendez-Villamil was under investigation.
David Lewis, director of the Medicaid Fraud Control Unit, said he never confirmed nor denied investigations, but speaking generally, “you need a whole lot more” than “the sheer volume of prescriptions to establish wrongdoing.”
To see if there were something wrong about a doctor’s prescribing practices could mean lengthy, detailed examinations of patient records, which state investigators rarely have time for, Lewis said.
On the Medicaid lists of mental-health prescriptions written from the third quarter of 2007 through the first quarter of 2009, Mendez-Villamil has written almost twice as many prescriptions as the No. 2 in the state, Huberto Merayo, whose Southwest Eighth Street office is a few blocks from Mendez-Villamil’s, on Coral Way.
In fact, the top seven prescribers of mental-health drugs in the state are all from Miami-Dade.
Miami-Dade is at or near the top, depending on the measure, of most expensive places for healthcare in the country. Grassley and many other Washington lawmakers have emphasized the need to reduce healthcare costs in order to pay for reform plans to expand coverage to the uninsured.