Medical Professional Goes on a Mass Fraud Frenzy.
Shrinks himself, his city (and profession) in just one event!
Deprives thousands of sick people of $$$ millions in Medicare and Medicaid!

Between autumn, 2007 and spring 2009, psychiatrist Dr. Fernando Mendez-Villamil wrote more than 96,000 prescriptions for his Medicaid patients. That’s almost twice the number of the second-highest prescriber in Florida. Mendez-Villamil saw nearly 60 patients a day, six days a week.
The drug of choice subscribed was quetiapine, used to treat psychosis and bi-polar disorder. It is sold commercially as Seroquel, on the streets as “Susie Q” or “Jailhouse heroin.” The patient’s prescriptions were paid for by Medicaid, then used, abused or sold. Like a regular drug dealer, new patients could not get appointments unless they were referred by an existing patient. Law officials concluded that none of the “patients” was ill.
At $45 per visit, the perpetrator would have taken in over $800,000 per year from about 1,500 “patients” per month at the peak of the 14 years of pernicious fraud.

U.S. citizenship fraud was another lucrative crime for this gang, the doctor and his employees. “Patients” paid $200 to $300 to cheat the U.S. citizenship test by falsely certifying that individual’s had mental impairments. This excused them from the English language and/or the civics requirement, both of which are normally essential in the process to become a citizen.
Between $1,500 and $3,500 would buy a fraudulent diagnosis of severe mental disorder. That was used to obtain long-term Social Security disability payments. The clinic would create years of dated fake patient records for cash. Files seized through a search warrant in 2011 were found to be pretty much identical in content and diagnosis.

The “employees” who handled appointments, paperwork and the usual chores were found to be similarly “disabled” and collecting SSI disability payments.

Senator Charles Grassley (R-Iowa), wrote to health-care officials, citing Mendez-Villamil’s outrageous rate of prescription-writing. The letter gained media attention and the psychiatrist was dropped from the Medicaid program in June, 2010. By 2013, he was barred from all billing privileges under the Medicaid program. A month later, a $15,000 fine was imposed, with a reprimand from the Department of Health and Human Services. Mendez-Villamil avoided jail and kept his license while a federal investigation into his activities continued.

A true recidivist, Mendez continued to conduct his frauds by falsifying patient mental conditions in order for them to acquire SSI benefits or pass the U.S. citizenship test, until an FBI agent posed as a regular “patient.” The conversation was recorded and a fee transaction of $1,500 was initiated so that the FBI agent could get the necessary documents supporting a condition of severe mental disability.

The false documents to the Social Security Administration and the tape recording of Mendez and his staff was the evidence needed to prosecute him. In May, 2016 Mendez-Villamil pleaded guilty to charges of health-care fraud.

Consequences:

Between 2002 and 2016, Mendez’s frauds resulted in Social Security paying $20.3 million in disability payments.

The Medicaid program was billed $25.9 million in false claims, of which $16.7 million was paid for office visits that never occurred and medication that were never used or needed.

The Medicare program was billed $15.8 million in false claims, of which $12.5 million was for office visits that never occurred and medication never used or needed.

The accounts of Mendez falsifying diagnoses for patients to pass the citizenship test cost the government $814,000.
Mendez was ordered to pay $50.7 million in restitution, is serving a 12-year sentence in federal prison, and he has lost his medical license.


Sources of data:

Christian Science Monitor, Miami Herald.

Perpetraitor(s):

> Dr. Fernando Mendez-Villamil. Maritza Exposito. Yomara Vila.
> Arnaldo Oscar Jimenez. All Miami residents.

Location(s):

Miami, U.S.

Crimes:

Health-care Fraud. Medicare Fraud. Being the dregs of society.

Timeline(s):

Event Reveal – December 2009. Duration c.2002 – 2016

Convictions:

Yes. Perpetraitor Sentenced to 12 Years Imprisonment.

Kudos:

Sen. Charles Grassley, R-Iowa publicly challenged the level and type of prescriptions. Florida AG Pam Bondi prosecuted.
Background: If readily available.

Regulating Authority/Auditors:

TBA

Aliases:

None.

Status:

Case closed.