Doctor wrote 1,000 scripts/week
By Carol Gentry
1/15/2010 © Health News Florida
Since 2004, a Miami psychiatrist has prescribed almost 14 million
pills to Medicaid patients at a cost to taxpayers of $43 million,
a state agency says.
Fernando Mendez-Villamil would have had to issue 4,000 prescriptions a
month, or 1,000 a week, to keep up that pace, according to the report
released this week by the Agency for Health Care Administration.
Altogether in the six years from 2004-09, he issued nearly 285,000
prescriptions, the AHCA report showed.
However, AHCA noted that that total counts a refill as a prescription.
The agency said its report does not conclude
that Mendez-Villamil's prescribing is improper; its investigation
Mendez-Villamil’s status as the most prolific prescriber in the state
was already known, based on a report released in December of a 21-month
period in 2007-09. But that period was mild compared to the years
before, the new data show, and a timeline suggests that the prescribing
slowed down markedly after the state began implementing computer
tracking and other controls.
His highest-prescribing year in the period studied was 2004, when he
issued about 62,400 prescriptions that cost Medicaid $12.2 million,
according to the chart. The number of patients: that year: 2,695.
A quick calculation shows that he issued 23 prescriptions (or refills)
per patient, for a total of more than 1,200 pills apiece.
Sen. Don Gaetz, chairman of the health regulation committee, said
Mendez-Villamil “appears to be taking advantage of the taxpayers of
Florida and draining money away from legitimate patients. He should be
the poster boy for tougher enforcement actions.”
Gaetz said he will ask sharp questions of AHCA officials at a hearing
in Tallahassee on Tuesday because he senses that lawmakers have been
"slow-rolled" -- repeatedly reassured that problems in Medicaid will be
fixed, only to see little progress.
"We need to be all over this guy" Mendez-Villamil, said Gaetz, R-Niceville. "We ought to be looking over his shoulder."
AHCA, which conducted the in-depth review of the psychiatrist's prescribing at Gaetz's request, released the results to Health News Florida as part of a broader freedom-of-information request.
Mendez-Villamil, reached by phone on Thursday, said his attorney had
asked him not to speak to the media. The attorney, Robert Pelier of
Miami, said he had not seen the report and questioned why AHCA was
“willing to share that information with you and not me.”
Pelier suggested that AHCA was trying to pressure psychiatrists to stop
prescribing “atypical antipsychotics,” which are more expensive than
older drugs for treating severe mental illness. When told of the
results of the review, Pelier said, “Based on the amount of patients he
sees, it’s well within normal range.”
Mendez-Villamil’s status as high-prescriber came to light in mid-December when The Miami Herald
named him as the psychiatrist targeted in a letter of protest to
federal Medicaid officials from Sen. Charles Grassley, R-Iowa, chair of
the Senate Finance Committee.
Grassley had learned of the psychiatrist from a report by the
University of South Florida’s behavioral therapy experts, who were
commissioned to profile prescribing patterns from the last half of 2007
through the first quarter of 2009. That report did not have names, but
the Herald obtained the name through other AHCA records.
In an interview, Mendez-Villamil told The Herald in
December that he prescribes only what is necessary. His practice style
– seeing patients for 10 minutes every two or three months for
medication checks – enables him to handle a large caseload, and many
patients are on four or five different drugs, he said.
“When you know the patient, and the patient is stable, 10 minutes is long enough,” the Herald quoted him as saying.
The mental health drugs that he frequently prescribes are expensive even at the online Drugstore.com, the Herald noted: Zyprexa, about $842 a month for 30 days; Abilify, $634; and Seroquel, $430.
AHCA noted in its response to Gaetz that the psychiatrist is one of
several “top prescribing outliers" who are under investigation by the
agency’s Bureau of Medicaid Program Integrity.
The agency referred a complaint about Mendez-Villamil to the Attorney
General’s Medicaid Fraud Control Unit in 2007, a timeline shows, and a
spokeswoman for that office said the investigation is still ongoing. In
2008, AHCA began to require prior authorization for prescriptions
of certain pricey medications that the agency suspected were
Mendez-Villamil’s prescribing dropped off sharply between 2004 and
2009, the AHCA chart shows. While some of the dropoff came with a
reduction in the number of patients he saw by about one-fourth, the
quantity of drugs plummeted by two-thirds – from 3.3 million a year in
2004 to 1.1 million in 2009.
When it comes to psychiatric medications, AHCA is under pressure from
many directions: Some patient advocates fear there
is over-prescribing to keep Medicaid patients docile, and that the
danger is especially great with children,
particularly in foster care. They point to last
year's suicide of a 7-year-old foster child who was on such
medications, a death that led to a continuing series of meetings to
hash out drug guidelines for children.
At the same time, patient advocacy groups fear money concerns will
influence the state to cut back on the costliest drugs even when
they're needed, especially at a time when Medicaid spending is
exploding and the state faces a deficit of more than $2.6 billion.
Meanwhile, drug-industry lobbyists push for inclusion of the
costliest new drugs on the state formulary of medications
that can be prescribed without "prior authorization."
--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.