Miami psychiatrist fined, reprimanded in Rx probe

A Miami psychiatrist who made national news for writing prescriptions for Medicaid patients at a rate of 150 a day, seven days a week, received what one U.S. senator called a “slap on the wrist” from Florida’s Board of Medicine during a disciplinary hearing this month.

Fernando Mendez-Villamil remains a licensed physician practicing psychiatry in his Coral Way office despite findings by the Florida Department of Health that he inappropriately prescribed medications at an inordinate rate and failed to meet professional standards, such as keeping concise patient records and performing necessary tests.

Mendez-Villamil, whose prescribing patterns came to light during congressional talks on the overuse of healthcare, declined comment through his attorney, Michael Gennett of Miami. But on Oct. 4, he accepted a settlement in which he admitted no wrongdoing but received a reprimand from the state Board of Medicine and a fine of $15,000.

Mendez-Villamil, 46, also agreed to pay the state up to $22,228 for costs of the investigation, and he will complete a course in “quality medical record keeping.” The agreement also requires Mendez-Villamil to hire a risk manager by mid-December to review his practice.

Sen. Charles Grassley, R-Iowa — who first brought attention to the huge numbers of prescriptions written by Mendez-Villamil — issued a statement Friday indicating that he felt the state medical board’s punishment would fail to deter future abuses of taxpayer-funded healthcare programs such as Medicaid.

“The state medical board reacted with a slap on the wrist,” Grassley said of Mendez-Villamil’s settlement agreement. “It’s hard to see how the state medical board could justify such a weak punishment. This raises concerns that over-prescription will continue to harm patients and taxpayers.”

According to state records, Mendez-Villamil was the top prescriber in the Medicaid program from late 2007 through early 2009, writing a total of 96,685 prescriptions — about 43,000 more than the second-highest Medicaid prescriber in the state for the same period.

Mendez-Villamil was terminated from Florida’s Medicaid program on June 21, 2010, said Shelisha Coleman, a spokeswoman for the state’s Agency for Health Care Administration (AHCA).

Coleman said Medicaid suspended all payments on his prescriptions after July 31, 2010, and that he remains ineligible for the program.

Mendez-Villamil sued AHCA in 2010 to have his Medicaid contract reinstated, but he asked to have the case closed in February and Leon County Circuit Court Judge Charles A. Francis dismissed the lawsuit in March.

The state’s investigation into Mendez-Villamil focused on three of his patients — including one who was age 3 when he began treatment — who received prescriptions for antipsychotics, amphetamines, anti-depressants and other drugs, including Xanax, Valium and Zoloft.

State investigators found that Mendez-Villamil did not refer patients or document referrals to specialists for evaluations of other potential conditions, nor did he substantiate or document his own diagnoses for conditions such as attention deficit hyperactivity disorder and other ailments.

In one instance, Mendez-Villamil prescribed a boy identified only as “Patient AT” a drug for impulsivity and, according to state records, wrote in documents that the boy, who was 5 at the time, was “able to take care of himself.’’

Mendez-Villamil also failed to justify the amounts, frequency or combination of prescriptions that he issued the boy, who was on at least three different medications including an anti-psychotic, an anti-hypertensive and a stimulant, according to state records.

In the case of another patient identified only as “Patient FB,” Mendez-Villamil prescribed four different medications — an antidepressant, two sedative hypnotics and an antipsychotic.

State investigators found that Mendez-Villamil entered contrary treatment plans for this patient, changed the patient’s medication multiple times despite describing him as “stable,” and accepted self-reported medical information from the patient, who was diagnosed as “psychotic.’’

State officials lodged charges of malpractice against Mendez-Villamil, alleging that he failed to refer patients to specialists when needed, failed to obtain necessary lab tests and neglected to perform a physical exam of one patient before prescribing medication with potential physiological side effects.

Mendez-Villamil did not respond to the state’s allegations in writing, but he did address the complaints against him in a January 2010 letter to Grassley, who had penned a biting letter to federal Medicaid officials in December 2009 that noted “with alarm” that a single prescriber had written 96,685 prescriptions from late 2007 through early 2009 for Medicaid patients.

In his letter to Grassley, Mendez-Villamil said he typically works 12-hour days and takes no vacations.

“I never thought I would be faulted for working hard or for being very organized and efficient,’’ Mendez-Villamil wrote.

But federal officials had been watching Mendez-Villamil since about 2004 — long before Grassley wrote his first letter about the physician’s prescribing patterns.

In a March 2010 letter from Health and Human Services Secretary Kathleen Sebelius to Grassley, Sebelius noted that the total amount Medicaid paid for prescriptions ordered by Mendez-Villamil had declined from $12.2 million in 2004 to $5.6 million in 2008, but that “the level of activity remains concerning.”

According to Sebelius’s letter, Mendez-Villamil also wrote $11.5 million in prescriptions billed to Medicare Part D, the prescription drug benefit program for the elderly, from January 2006 through December 2009, an average of $2.89 million a year.

State records show that in 2009, Mendez-Villamil was the state’s top prescriber of Abilify, Seroquel, Alprazolam (a generic of Xanax), and Zyprexa — for a cost of $4.8 million to Medicaid.

While Mendez-Villamil was an outlier, Miami does have some of the highest healthcare costs in the nation.

A Dartmouth Atlas Project study released this month found that the average Medicare Part D patient in Miami spent $4,738 on prescription drugs in 2010, more than any other region and well above the national average of $2,968.

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