MIAMI (AP) -- The federal government has stopped
reimbursing a Miami doctor who wrote nearly 97,000 prescriptions for
mental health drugs to Medicaid patients over 18 months, in a case that
prompted a key Senator to call for a nationwide investigation.
Sen. Sen. Charles Grassley of Iowa said 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.
an Iowa Republican and ranking member of the Senate Finance Committee,
which oversees Medicare and Medicaid, called the figures alarming and
sent a letter Wednesday to the Department of Health and Human Services
asking the agency to investigate top prescribers across the country.
His inquiry comes as the government targets waste and fraud in the
taxpayer funded programs.
HHS officials said
they were aware of Florida's list of high prescribing doctors and were
working closely with the state and federal agencies that investigate
Medicaid fraud, according to a statement from Sec. Kathleen Sebelius'
Dr. Villamil hasn't been reimbursed by Medicare since May when HHS started investigating him.
An employee at Villamil's office declined to comment and a voicemail left at his office Thursday was not immediately returned.
"It's hard to believe that this dramatic level of activity could go unnoticed," Grassley told The Associated Press.
a matter of program integrity, taxpayer protection and patient safety,"
added Grassley, who asked HHS officials to explain whether and how the
agency tracks high-prescribing doctors.
vast majority of the doctors near the top of Florida's list are in the
Miami area, where Medicare fraud totals over $3 billion a year, higher
than any place else in the country.
highest prescribers are always in Miami," said Karen Koch, vice
president of the Florida Council for Community Mental Health. "They
tend to use medication more maybe than in some others areas and then
sometimes it's an anomaly in the data."
said that some doctors on the list have multiple practices with other
prescribers using their license, which is legal. The state also has a
shortage of psychiatrists, meaning a smaller number of doctors are
serving more patients each.
And sometimes patients doctor shop with the intention of selling the drugs, which also drives up prescription numbers.
The drugs that Villamil, a psychiatrist, prescribed most commonly included Seroquel, Zyprexia and Abilify.
is the only drug that has street value in the United States. "When
snorted, it acts like cocaine," said Koch. The other drugs "have high
street value in South American countries because it is not available
there so families in the U.S. are always trying to get it for their
relatives there," she said.
The state's top
prescriber list is part of the Medicaid Drug Therapy Management
Program, which began monitoring mental and behavioral health
medications when the program was created in 2006.
number of prescriptions recorded for Dr. Fernando Mendez-Villamil is
high when compared to other Medicaid prescribers," state Agency for
Health Care Administration spokesman Sue Conte said in an e-mail to The
However, she said "it does
not indicate that there is anything improper regarding his
prescribing," saying patients seeing a specialist like Villamil would
need daily medications plus medications for acute episodes. Villamil's
prescriptions also included refills, she said.
a concern arises, AHCA's Office of Inspector General will more
thoroughly investigate billing practices and prescribing patterns. If
fraud is suspected, the case is sent to the Florida's Attorney General.
About 123 cases were referred to the Medicaid Fraud unit in the past
fiscal year, according to AHCA.
for Florida's Attorney General said the office has a pending
investigation into Villamil, stemming from a 2007 request from a
private citizen. She declined to comment further.
Florida doctor who prescribed several mental health medications to a
7-year-old foster care boy who killed himself in April is also on the
list. The drugs carried a special FDA black box warning indicating they
can cause suicidal thoughts and are not approved for young children,
though some doctors still prescribe them to treat children.
Dr. Sohail Punjwani wrote 10,150 prescriptions during the same two year period, according to the report.
Punjwani, who has appeared on the high-prescriber list multiple times
but has never been sanctioned, did not immediately return a phone call
left by The Associated Press on Thursday.
letter comes months after Gabriel Myers hung himself with a shower cord
at his foster parents' home while under Punjwani's care. The boy's
death prompted debate at the state's child welfare agency about
stricter rules for prescribing powerful antidepressants and other drugs
to foster children.
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