Federal, state authorities slow to react to high prescribers

Pill capsules laying on dollar bills

Two of Florida’s highest antipsychotic prescribers continued billing Medicare Part D for years after they were kicked out of the state’s Medicaid program, spotlighting gaps in cracking down on physicians suspected of fraud, according to ProPublica.

In 2009, Sen. Charles Grassley (R-Iowa), wrote a letter to Medicaid officials highlighting the prescribing patterns of Miami psychiatrist Fernando Mendez-Villamil, who dispensed nearly 97,000 prescriptions between 2007 and 2009. Although Florida authorities were aware of his high billing patterns for years, Mendez-Villamil wasn’t barred from Medicaid until 2010. Even after he was terminated from Medicaid, he continued billing Medicare Part D, writing 47,000 prescriptions worth $6 million between 2011 and 2013, according to ProPublica. Last month, seven years after Grassley’s letter, Mendez-Villamil pleaded guilty to healthcare fraud charges.

Another Miami psychiatrist with high prescribing rates, Huberto Merayo, was charged with healthcare fraud in 2012 after Florida revoked his Medicaid privileges a year earlier. Merayo continued billing Medicare Part D from 2011 to 2013, and even continued submitting claims after he pleaded guilty to the charges.

In 2014, the Centers for Medicare & Medicaid Services issued a rule requiring Part D prescribers to enroll in Medicare by June 1, 2015, which federal officals hoped would prevent terminated physicians from billing other programs. But that deadline has been pushed back twice, first to June 2016, and most recently to Feb. 1, 2017.

The OIG has repeatedly pointed to questionable billing patterns with the Part D program, while other reports have found physicians banned from Medicaid in one state have routinely submitted claims to other states. Last year, a Reuters report found that one in five physicians terminated from Medicare or Medicaid programs submitted claims in other states, totaling at least $79 million.

For more:
- read the ProPublica article