Bloomberg Business Week
The Associated Press October 21, 2010

A key U.S. Senator is asking federal officials to investigate after reviewing data that shows doctors across the country prescribing alarmingly high numbers of powerful mental health drugs paid for by Medicare and Medicaid.

U.S. Sen. Charles Grassley of Iowa studied Medicare and Medicaid prescription rates from doctors around the country, revealing few consequences for doctors with high prescription rates. The findings include a Miami doctor who wrote nearly 97,000 prescriptions in 18 months for mental health drugs for Medicaid patients and an Ohio physician who wrote about 102,000 prescriptions in two years.

A Texas doctor wrote 14,170 prescriptions for the anti-anxiety drug Xanax in 2009, far exceeding other high prescribers in that state. The 10th highest prescriber in Texas for Xanax wrote 1,696 prescriptions in 2009, according to Grassley.

\”The federal government has an obligation to figure out what\’s going on here. The taxpayers are footing the bill, and Medicare and Medicaid are already strained to the limit,\” Grassley said in an email to The Associated Press on Wednesday. \”These programs can\’t spare a dollar for prescription drugs that aren\’t properly prescribed. The conclusion might be that there isn\’t any fraud, but it\’s important to reach a conclusion one way or the other and fix whatever is broken.\”

The Republican senator is a ranking member of the Senate Finance Committee, which oversees Medicare and Medicaid.

The federal government does not investigate doctors who prescribe suspiciously high rates of drugs for fraud, and instead lumps them into a separate category where they are referred for medical review or education, according to Grassley\’s investigation.

Critics say the medical reviews are nothing more than a slap on the wrist for doctors, allowing the Centers for Medicare and Medicaid Services to ignore the role prescription drug fraud plays in the estimated $60 to $90 billion a year Medicare fraud problem.

The agency contracts with private providers who are responsible for monitoring Medicare prescription rates and other billing aberrations. State health departments monitor similar data for Medicaid.

Grassley sent a letter Wednesday asking Department of Health and Human Services Sec. Kathleen Sebelius to explain how the agency ensures contractors are properly monitoring and reporting the data. He also asked her to explain why \”possible overutilizers\” are treated differently than those suspected of fraud.

CMS did not immediately comment Thursday morning.

\”Medicare\’s contractors could be evaluating prescription patterns in real-time to assess whether abusive practices are occurring. It is like reading the receipt before you pay the bill — something most Americans do every day,\” said attorney Kirk Ogrosky, former federal prosecutor and partner at Arnold & Porter

Grassley did not name the doctor, but state records obtained by The AP show Dr. Fernando Mendez-Villamil wrote an average of 153 prescriptions a day for 18 months ending in March 2009. That\’s nearly twice the number of the second highest prescriber in Florida, who wrote a little more than 53,000 prescriptions, according to a list compiled by state officials.

The doctor\’s attorney, Robert Pelier, said his client tried to contact Grassley to explain the data but got no response.

\”Dr. Mendez-Villamil is a specialist that has treated the most afflicted and poor in the area\” and has never acted improperly, Pelier said. He filed a lawsuit against the state alleging authorities tried to terminate him from being a Medicaid provider \”without cause.\”

Federal officials said they stopped reimbursing Villamil after Grassley inquired about the doctor to HHS in December.