Citizens' Issues
Florida Doctor Pleads Guilty to Fraud — Years After Complaints About His Prescribing

Seven years after a U.S. senator cited him as a national example of aberrant practices, the onetime top prescriber of antipsychotic drugs in Florida's Medicaid program is in federal custody awaiting sentencing on fraud charges.


The second-highest prescriber is serving a four-year term in federal prison after pleading guilty to fraud charges in 2012, but he only relinquished his license to practice medicine in Florida last fall.


Taken together, the cases illustrate how long it can take regulators and law enforcement to take action against problem doctors 2014 and how those physicians can continue prescribing drugs paid for by taxpayers in the meantime. In 2011, ProPublica wrote about the suspicious prescribing patterns of the two Miami-area psychiatrists, Fernando Mendez-Villamil and Huberto Merayo.


Questions about the doctors' prescribing were first brought to light by Ken Kramer, a private investigator in Clearwater, Florida, who runs a website that compiles public records on psychiatrists. He complained to Florida's Medicaid fraud unit in 2007 that Mendez-Villamil appeared to be prescribing a disproportionate amount of the antipsychotic Abilify to children.


"Talk about slow justice," he said in an email to ProPublica, when sharing news that Mendez-Villamil pleaded guilty in May to an array of federal charges.


Prompted, in part, by the information Kramer gathered, Sen. Charles Grassley, R-Iowa, pressed Medicaid directors in all 50 states to explain how they were monitoring top prescribers of antipsychotics, narcotics and other risky drugs. He also demanded a list from each state of the top 10 prescribers of eight drugs and whether any action had been taken against them.


"When I started looking at top prescribers a few years ago, there was a frustration that state and federal authorities were slow to look at the problem," Grassley, who is now chairman of the Senate Judiciary Committee, said in an email to ProPublica. "That has to change. Patients are served badly by doctors who commit fraud."


Mendez-Villamil wrote more than 96,000 Medicaid prescriptions for mental-health drugs from July 2007 to March 2009, more than any other physician in Florida, according to a document released by Grassley at the time. In 2009 alone, he prescribed about $4.7 million in antipsychotics to Medicaid patients, other records showed.

Documents showed that Florida had known since at least 2004 that Mendez-Villamil was a problem, but did not bar him from billing Medicaid until 2010 after Grassley made his prescribing record public. Even then, it terminated him officially "without cause," a fast way of removing a doctor from the program, but without subjecting him to disciplinary action by other states or the federal government.


In 2013, he was reprimanded, fined and ordered to take a class by Florida's medical board.


After he was terminated from Medicaid, though, Mendez-Villamil continued prescribing drugs to patients in Medicare, the federal insurance program for seniors and the disabled. From 2011 to 2013, the most recent year for which data is available, he wrote nearly 47,000 prescriptions worth more than $6 million in Medicare's drug program, called Part D.


In a letter to Grassley in 2010, Mendez-Villamil wrote that his prescriptions were justified by his busy practice. And in a 2011 interview, his lawyer said he was "collateral damage" in Grassley's campaign.


Last month, Mendez-Villamil, 49, pleaded guilty to felony charges of conspiracy to commit health care fraud, conspiracy to defraud the government by making false statements with respect to immigration matters, and conspiracy to defraud the government with respect to claims. He admitted to lying on immigration forms to help people skip English and civics tests needed to become citizens and helping people fraudulently obtain Social Security disability benefits. The doctor agreed to forfeit more than $30 million. He is in federal custody as he awaits sentencing next month.


Merayo, 64, ranked second for prescribing mental-health drugs in Florida Medicaid from July 2007 to March 2009. In 2009 alone, he prescribed nearly $2 million worth of antipsychotics to Medicaid patients.


In 2011, Florida summarily ended his Medicaid contract, also "without cause," after a state review found he hadn't documented why patients were prescribed the antipsychotic pills and had given them to patients with heart ailments or diabetes despite label warnings.


At the time, his lawyer said the doctor had not been advised of any allegations of billing irregularities.


In 2012, federal prosecutors charged Merayo with health care fraud for signing medical diagnosis and treatment forms "knowing that the patients he was supposedly treating and supervising the treatment of did not qualify for the services he purported to provide." He agreed to plead guilty the same day. He was sentenced to four years in prison in 2013 and ordered to pay $6.7 million in restitution.


Like Mendez-Villamil, Merayo continued prescribing in the Medicare Part D program after he was terminated from Florida's Medicaid program. From 2011 to 2013, he wrote 22,460 prescriptions, worth almost $2.5 million. More than 1,200 of those prescriptions were attributed to him in 2013, months after his guilty plea.


Florida's medical board does not appear to have taken action against Merayo based on his conviction. Instead, in 2015, it accused him of medical malpractice and other wrongdoing related to his care of two patients on psychotropic medications. In addition to relinquishing his license last year, he agreed to never reapply.


Florida's Agency for Health Care Administration, which runs Medicaid, said in a statement that it now uses data analytics and audits to examine prescribing outliers. But because Medicaid services are now predominantly delivered through managed-care plans, that shifted "the principal oversight and management duties to the contracted managed care plans and their anti-fraud units."


The doctors could not be reached for comment. An attorney for Mendez-Villamil, Jorge Viera, declined to comment because his client has not yet been sentenced.


The Centers for Medicare and Medicaid Services, which is in charge of Medicare and Medicaid, also declined to discuss the specific cases but said it is working to ramp up its fraud fighting efforts.


CMS also is trying to compel health providers to enroll in Medicare to order medications for patients covered by Part D. That would close a loophole that has allowed some practitioners to operate with little or no oversight from Medicare.


But Medicare has pushed back the effective date of this requirement twice now, from June 2015 to next year. Until prescribers are required to enroll in Medicare, it's harder for the program to take actions against those who prescribe in abusive ways, said Shantanu Agrawal, director of CMS' Center for Program Integrity.


"Right now, we can analyze a lot of data in Part D because we do have good access to data but without that enrollment lever [the ability to terminate abusive prescribers], we are not able to take as many actions," he said.


Agrawal also said CMS is working with states to ensure that when a provider is terminated by a Medicaid program for abusive prescribing, that the action be labeled as such and not as a "without cause" termination, as happened in the cases of Mendez-Villamil and Merayo.


Terminations for cause prompt other states to act, while those without cause do not, he said. "I think it's extremely important that we label these cases the right way," Agrawal said.


For his part, Grassley said he hopes Mendez-Villamil's case will serve as an example of how all those involved can improve. "State and federal prosecutors should use this high-profile case as an example of how to use data for the public good," he said by email. "If someone is writing more prescriptions than seems humanly possible, that's a red flag for fraud and potential harm to patients. It pays to investigate, and time is often of the essence."


ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.


Ace stock-picker Vijay Kedia gives stock lessons
Vijay Kedia took the audience through his fascinating and inspiring journey as an investor at a Moneylife Investors Club seminar held at the iconic BSE International Convention Hall in Mumbai. The seminar “My Investment Journey So Far & What I learnt from my failures” was sponsored by BSE Investors' Protection Fund.  
Shankar Jadhav, Head - Strategy at BSE, in his introduction to the seminar said 'We want investors to be aware.'
Mr Kedia who is a very suceessful private investor in his own right, narrated a number of poignant experiences from his personal and professional life that have made him the stellar wealth creator that he currently is. These include childhood experiences involving perseverance to join NCC to many failures in stock trading over the first 10 years of his life and fascinating experiences in the later stages of life as an investor. 
The stock wizard who has picked up a number of multi-baggers over the years said that his present situation is based on whatever he could learn and adapt from his failures. A number of times in his life, he had to start from zero. He listed a number of events where he failed and the lessons learnt from them. Vijay Kedia said that these experiences have made him rich and led him to become a smarter person. 
Very few people would know that this extraordinary wealth-creator had actually quit the stock-market and started supplying materials to tea gardens. He came back into the stock markets again and again and started to acquire knowledge about the stock and investing process. He started following succesful investors in the market and reading about companies. He believes that 'Passion is a greater force than luck.'
Many people were not very keen on providing knowledge during those days. Vijay Kedia said, ' I tried to read in between the lines in order to learn why investors were buying a particular stock.' He remarked, ' When it comes to stock markets, mental capacity is more important than financial capacity.'
Highlighting the importance of experiencing a bear market for an investor, he remarked, “If you have not faced a bear market, you are not a seasoned investor yet.” He went on to explain his strategies behind an enviable list of multi-baggers including Aegis Logistics, Mico, Atul Auto and Cera Sanitaryware.
'Knowledge, courage and patience are critical if you want to invest in stock markets,' said Mr Kedia.
The session ended with an insightful Q & A session. 
Questions covering diverse topics including management quality, ideal size of portfolio and high PE stocks were covered. Highlighting the importance of being well informed for an investor, he said, 'Your job is to read, read and read.'
This was the 6th Investor Club event. The previous events can be accessed here: 




Harjeev Singh Chadha

4 months ago

waiting for the video to come out. Any idea when it'll be released and available for purchase?

Rishabh Adukia

4 months ago

The videos must be available free of cost, specially when its funded under investor protection fund. this is the money of investors

Bhavesh Rakhasia

4 months ago

Its was indeed great to listen to Vijay Kedia share his life journey in Stock market. All the difficulties he faced, learnings from his failures and his investment philosophy. It has cleared my mind and make me understood what mistakes i should not commit in Stock Market as a young investor.

Ameet Patel decodes capital gains at Moneylife Foundation seminar
Capital gains can be extremely confusing for an average taxpayer. Different rules and tax rates apply for different assets and there are other complexities such as indexation, and exemptions. Chartered Account (CA) Ameet Patel simplified the computation of capital gains to an audience at the Moneylife Foundation seminar sponsored by Capital First. Mr Patel, former president of the Bombay Chartered Accountants Society (BCAS), also answers tax related queries on Moneylife Foundation’s Tax Helpline on a voluntary basis. 
CA Patel commenced the session by defining a capital asset. “A capital asset may be a short term or long term depending upon the period for which the asset is held. This can be confusing for an average taxpayer as there are different periods for different assets for defining whether it is a short-term asset or a long-term asset. For instance, in case of shares of unlisted company, if the holding period does not exceed 24 months then it is a short-term asset. However, for shares held in recognised stock exchange in India, the period is merely 12 months,” he said. 
He went on to explain that indexation benefit is given while computing long-term capital gains (LTCG) in order to ease the burden of inflation. In order to dispel any confusion among the audience, Mr Patel illustrated the computation of capital gains with numerical examples showing both the options – with indexation and without indexation. 
Certain taxpayers may end up paying excess tax without knowledge of a number of exemptions available under the Income Tax Act. Section 54 is one of the most important sections for saving tax arising from capital gains on sale of residential property. CA Patel explained the conditions under which this exemption can be claimed. Section 54EC is another important provision, where long term capital gains can be invested in specified bonds in order to claim exemption. However, he highlighted that Rs50 lakhs is the upper limit while claiming exemption under Section 54EC.
Those who invest a lot in shares should know what expenses are allowed as a deduction while computing capital gains on sale or purchase of shares. Securities Transaction Tax (STT) is not allowed as an expense, while expenses like brokerage, service tax, stamp duty are allowed, he said. 
“A significant number of taxpayers don't maintain proper documents,” said Mr Patel. This leads to a number of problems as proof is required in law if there is a scrutiny. Maintaining documents related with immovable property (even old documents) is extremely critical. While buying or selling immovable property, it is important to take a receipt for brokerage paid to real estate agents in order to prevent disallowance of expenditure. 
Mr Patel said, Section 50C of the Income Tax Act is also extremely critical. If the value stated in an instrument of transfer is less than the value adopted by stamp duty authorities, then stamp duty value is considered for the purpose of computation of capital gains on land or building. For instance, if an agreement states that the valuation of a flat is Rs30 lakhs, but stamp duty authorities value it at Rs40 lakhs, then stamp duty value (Rs40 lakh) will be considered for the purpose of computation of capital gains. This will lead to higher capital gains on the transfer.
Mr Patel ended the session advising taxpayers to comply with income tax provisions as information related to high value financial transactions is disclosed in the Annual Information Return (AIR). 
He patiently answered a number of questions posed by an eager and inquisitive audience. The questions covered issues like number of years for which records need to be maintained, income tax refunds and income tax return (ITR) forms for different categories of taxpayers. There were a number of queries related to capital gains on sale of immovable property covering issues like the date on which capital asset is purchased and the period for which indexation benefit is available.  



sandeep shet

4 months ago

Hi, I have one question. If you own listed shares of a foreign company, which is listed outside india, what is the time limit for it to be long term? Will it still be one year or three years?

We are listening!

Solve the equation and enter in the Captcha field.

To continue

Sign Up or Sign In


To continue

Sign Up or Sign In



The Scam
24 Year Of The Scam: The Perennial Bestseller, reads like a Thriller!
Moneylife Magazine
Fiercely independent and pro-consumer information on personal finance
Stockletters in 3 Flavours
Outstanding research that beats mutual funds year after year
MAS: Complete Online Financial Advisory
(Includes Moneylife Magazine and Lion Stockletter)