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.