By John Dorschner
Medicare has stopped paying claims to Miami psychiatrist Fernando Mendez-Villamil because of questions regarding the amount of mental health drugs he prescribed, an average of 150 prescriptions per day during 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. Charles Grassley, R-Iowa, asking Medicare and Medicaid officials if they had any programs in place to flag overutilization, 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 said 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.
According to Medicaid records from the third quarter of 2007 through the first quarter of 2009, Mendez-Villamil wrote almost twice as many mentah health 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 County.
Miami-Dade is at or near the top, depending on the measure, of most expensive places for health care in the country. Grassley and many other Washington legislators have emphasized the need to reduce health care costs in order to pay for plans to expand coverage to the uninsured.
“The overutilization of health services, whether through the use of higher-cost or unnecessary drugs, devices, or procedures, plays a significant role in the rising cost of our healthcare system,” Grassley noted in his letter to Kathleen Sebelius, secretary of Health and Human Services.
On Wednesday, Vause said that Mendez-Villamil’s prescription rate was high but could be explained by various reasons. By itself, his numbers did not “indicate that there is anything improper regarding his prescribing.”