From the Christian Science Monitor (a newspaper with a distinguished history but I'm surprised it's still around):
In December 2009, the Iowa Republican demanded to know how a Miami psychiatrist was writing more than 96,000 prescriptions for Medicaid patients. It was nearly twice the number of the second highest prescriber in Florida.
The psychiatrist, Dr. Fernando Mendez-Villamil, responded with a tartly worded message of his own. “I never thought I would be faulted for working hard or for being very organized and efficient,” he wrote the senator. ...
Even after Dr. Mendez-Villamil was kicked out of Medicaid and barred from Medicare, he continued to operate an elaborate network of bribes, kickbacks, and payoffs that helped hundreds of fake patients fraudulently obtain Social Security disability payments. ...
Through a check of pharmaceutical records, Crespo [the detective investigating the case] discovered that the doctor was prescribing large amounts of quetiapine, a drug approved to treat psychiatric patients diagnosed with bipolar disorder. It is sold commercially under the name Seroquel.
According to federal agents, there is a well-established black market in quetiapine, with street names including “jailhouse heroin,” and “Susie Q.” ...
Crespo found that many of Mendez-Villamil’s patients were receiving Social Security disability payments. The doctor had provided the medical assessments necessary to verify that his patients’ mental conditions rendered them completely disabled. Acting on those medical assessments, the Social Security Administration had awarded a large number of his patients full disability benefits. ...
Crespo estimates that Mendez-Villamil helped 3,500 to 3,800 individuals fraudulently obtain Social Security disability payments. “At one point he was disabling up to 10 people a week,” the agent says.
For $1,500 to $3,500 in cash, Mendez-Villamil would falsely diagnose anyone as having a severe mental disorder that would qualify him or her to receive Social Security disability payments. ...
Once the payment was received, the doctor’s staff prepared a patient file that was typically back-dated a year or more to show the condition was chronic and to create a fake paper trail purporting to document a prolonged period of medical treatment, according to court documents.
“It was just straight back-dating, you come in today and I started treating you last year,” the agent says. ...
Crespo wasn’t the only government official concerned about Mendez-Villamil. “I had administrative law judges calling me and telling me this guy is a crook,” the agent says. ...
Confronted with the fruit of Crespo’s detailed investigation, Mendez-Villamil pleaded guilty to health-care fraud in May 2016. He agreed to pay the government $50.7 million in restitution. He is serving a 12-½ year sentence in federal prison and has surrendered his medical license.
According to a statement signed by Mendez-Villamil as part of his guilty plea, the psychiatrist’s false diagnoses caused Social Security to make $20.3 million in undeserved disability payments to various “patients” between 2002 and January 2016. ...
With Mendez-Villamil behind bars, the question remains: What about all those patients fraudulently receiving Social Security disability payments?
“A lot of them are now off the rolls and are starting to pay the government back,” Crespo says. ...I have a few thoughts. First, I've never before heard of Seroquel abuse. Apparently, it is a thing but I don't think it's a big thing. One thing that kept this going was that the doctor apparently avoided prescribing opioids or benzodiazepines. Large numbers of prescriptions for those drugs, which have important medical uses but which are commonly abused, would have been a red flag that would have more quickly brought down this doctor. Second, where was Florida Disability Determination Services (DDS)? They make determinations at the initial and reconsideration levels on Social Security disability claims. They should have been the first to ask questions about what this doctor was doing. I'm glad to see that ALJs were raising a red flag. Third, I've been representing Social Security disability claimants since 1979 and I've never seen anything like what this physician was doing. I've seen at least a couple of cases where it seemed obvious that a physician was operating a Medicaid mill and was probably involved in Medicaid fraud but there was no Social Security involvement. I know that both of those physicians were investigated repeatedly. I never had any information on them that would have helped an investigator. Reports from these physicians were almost completely useless in proving disability. Their office notes were mostly illegible scribbles. If you're running a Medicaid mill, you don't take the time to create real office notes. Even if the notes had been legible, ALJs knew not to trust anything these physicians said. I routinely advised clients who were seeing these physicians to change doctors.
I would tend to agree. What the guy did was wrong and he was properly caught, jailed and fined. However, it is laughable to think that SSA would find a person disabled for an affective disorder based on just a prescription for seroquel and a page or two of scribble scratched notes from a high volume mental health practice. Take a look at listing 12.04 and see how far that gets you.
ReplyDeleteThere is the suggestion in the story that people were found disabled in some way because
ReplyDelete"Mendez-Villamil would falsely diagnose anyone as having a severe mental disorder that would qualify him or her to receive Social Security disability payments. ..."
" “At one point he was disabling up to 10 people a week,” the agent says."
as if that is all it took. In my experience, over 40 years on both sides, it is hard to imagine that one doctor reporting bi-polar disorder all by itself would be sufficient to get anyone found disabled.
There is no way for me to verify or question the numbers of questionable or phony claims reported in the article. It just seems that it is more furthering the notion that it is easy and routine to get Social Security Disability benefits based on the say so of one doctor when that could not be farther from the truth.
"ALJs knew not to trust anything these physicians said."
ReplyDeleteYet they routinely put the observation of a doctor running a SSA Denial Mill, that is paid by SSA, that saw a Claimant for 15 minutes (if you are lucky) and who have medical notes that make no sense and often are internally contradictory.
Seems fair to me.
GREAT POINT, 9:40!
DeleteThere was a similar scam in south Texas that was focused on worker's comp fraud. Some ALJ's were wondering why claimants with little wrong in their medical file were suddenly in terrible shape after traveling several hundred miles to the clinic, but apparently most of those came in to ODAR after the arrests had been made.
ReplyDelete@ 9:40, well said
ReplyDeleteCouldn't agree any more strongly with 9:40. These doctors often get the full credibility of an ALJ intent on keeping up the pretense that ODAR is fair and impartial when such exams are a sham. Especially when it is the same doctor, time after time after time!!
ReplyDeleteAttorney purchased medical and questionable medical sources with repetitious similar conclusions have been ignored at the ODAR I practice in front of since I can remember back to the 1990's. Of course SSA uses the same retiree or limited practice doctors or mill sources all of the time. These stories are designed to give the public the impression that this is happening everywhere all of the time. This type of slanted journalism is also effective because I pretty much now hear all the time from new clients that their undeserving neighbor down the street getting benefits is ruining it for them. They don't understand that the ultimate goal of the top percentage of one percent now running and owning this country is that nobody gets anything, except them of course.
ReplyDeleteAbout DDS, Charles - in my state, the field offices are farming out the DDS work all over the state, and into the neighboring states. So it would be easier for such a scheme to work, if the DDS offices are not all local.
ReplyDeleteI, too, was shocked to learn that people trade in Seroquel, but I had a couple of homeless clients who were constantly losing their Seroquel. I learned about the abuse potential that way. Odd.