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Sunday, January 17, 2010

FYI: Is This Medicare Fraud???

Just an article, I received via email... Plus, there has been alot about Medicare Fraud and Health reform.. Here is the article. and at the end of this post, if you know of any fraud, I've included links

pharma

http://www.miamiherald.com/business/v-fullstory/story/1428212.html

Miami Herald

HEALTHCARE | DR. FERNANDO MENDEZ-VILLAMIL

Miami psychiatrist defends his record over prescriptions

A state senator said a Miami psychiatrist `should be a poster boy' for tougher enforcement, while the doctor says he's been unfairly targeted

January 16, 2010

By John Dorschner

A Miami psychiatrist who wrote 284,908 prescriptions over the past six years has cost Florida taxpayers $43 million, and a state senator said Friday that ``he should be a poster boy'' for a legislative inquiry into whether ``tougher enforcement provisions are needed.''

The practices of Fernando Mendez-Villamil, who has an office on Coral Way, came to light last month when Sen. Charles Grassley, R-Iowa, complained about him to federal authorities for writing prescriptions at a rate of 150 a day, seven days a week. Grassley, like many in Congress, is concerned about reducing America's high healthcare costs to reform the system.

The Florida Agency for Health Care Administration has released data showing that those prescription-writing practices were expensive, too -- since the patients had Medicaid, the state-federal insurance for the poor.

State Sen. Don Gaetz, R-Destin, chairman of the Senate healthcare committee, told The Miami Herald on Friday that the Legislature has ``a tough law already on the books'' that requires state regulators to investigate outliers like Mendez-Villamil, who writes twice as many anti-psychotic drugs as any other doctor in the state. But his case may mean the law needs to be tougher.

Mendez-Villamil prepared a lengthy response to Grassley, defending his record. He said he is a dedicated doctor helping many poor patients, often working 11 or 12 hours a day, six days a week.

``I may be an oddity as a physician because I do not play golf, I do not have a boat and I seldom leave my practice for extended vacations,'' Mendez-Villamil wrote in the letter provided to The Miami Herald by a publicist. ``That is not to solicit sympathy or to appear `noble.' I am simply committed to my patients, profession and enjoy what I do and do not seek distractions.''

Mendez-Villamil also disputed earlier Herald stories, which said that he was under investigation by state regulators and that Medicare, the federal program for the elderly and disabled, had stopped paying his claims because of the investigation.

``The information received from this agency [AHCA] advised that I am not under any sort of investigation,'' Mendez wrote in a letter dated Monday, Jan. 11.

However, AHCA on Friday forwarded The Herald a letter sent Thursday to Robert Pelier, the doctor's lawyer, stating ``an agency investigation is underway.''

Pelier told The Herald on Friday that AHCA was sending out mixed signals. He pointed to the first Herald story on the doctor, published Dec. 17, in which an AHCA spokeswoman said the high prescription rate does not ``indicate that there is anything improper regarding his prescribing.''

A day later, the state told The Herald there was indeed an investigation.

Mendez also wrote: ``I was very surprised to read in The Miami Herald [in a Dec. 18 story] that Medicare had supposedly stopped payment for my services; and I am very pleased to confirm with Medicare officials that this was NOT true.''

Pelier, Mendez's lawyer, said Friday that the doctor as late as Dec. 21 had received a Medicare payment.

Medicare spokesman Peter Ashkenaz said Friday, ``When I said he wasn't being paid back in December it was because we were reviewing all of his claims. It's likely that he received a Medicare payment, but nonetheless, we are continuing to review all of his claims because he has not been excluded from Medicare by the OIG,'' the Office of the Inspector General.

The Mendez-Villamil case comes at a time when reformers are seeking to reduce the nation's healthcare costs, which are twice as much per capita as in European countries. Reformers believe these costs can be reduced without affecting quality of care.

Grassley has pressured the U.S. Department of Health and Human Services, which provides Medicare and Medicaid funding, for an explanation on how one doctor could write so many prescriptions. So far, HHS has yet to respond to the senator.

On the state level, Sen. Gaetz said he has long been concerned with Medicaid expenditure patterns that seem to make no sense -- such as the average Miami patient getting five times as many home healthcare visits as a similar patient in Ocala.

Gaetz said he views the Mendez-Villamil case as a way of revealing whether the present law is adequate of if it's an ``enforcement problem and the state agencies are not doing enough.''

If the law needs tightening, ``then we will tighten the screws as many times as necessary'' because ``providers like him should not be draining money out of the pockets of taxpayers,'' Gaetz said.

Pelier, the attorney, said that the state was wrongly preoccupied with saving money on the atypical anti-psychotics, which can cost more than $800 for a month's supply per patient. He said that only 1 percent of the doctor's patients are hospitalized. If they weren't taking the drugs and ended up in the Jackson psych ward, for example, the cost to taxpayers would be far higher.

State records indicate that Mendez-Villamil was paid $46,238 by Medicaid to see patients in 2007 and $31,735 in 2008. He received $14,579 in the first quarter of 2009, but then payments dropped down to $3,472 in the third quarter.

``I want you to know that I take very good care of my patients,''' the doctor said in his letter. ``My top priority is to improve their conditions. In more then 10 years of practice I have worked with thousands of afflicted individuals.''

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May YOU find Strength in YOUR Higher Power, GranPa Chuck
Never Give Up PS: I am not a Lawyer. Just an ol'guy who has shared many experiences.
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