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SD refuses to release names of docs kicked off Medicaid

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news Mitchell, 57301
Mitchell South Dakota 120 South Lawler 57301

A Florida man says South Dakota is the only state government in the country that refuses to give him information on physicians who have been excluded from Medicaid.

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Ken Kramer, of Clearwater, Fla., said that should be public information. Kramer has spent the past 15 years of his life documenting what he views as the abuses of the psychiatric profession. His website, PsychSearch.net, is a compilation of public records about ethical misbehavior, over-prescription of medications, sexual misconduct and Medicaid fraud.

He offers his research as a free public service.

“You name the crime,” said Kramer, who said the website is a public service informational project of DataSearch Inc., a public records research and retrieval company he founded in 1998. Kramer earns his living doing public records searches for clients.

In July, he asked the South Dakota Department of Social Services for the names of every medical doctor and osteopath who has been terminated or excluded from Medicaid, a federal health care program for the poor, since 2010.

Individuals or companies may be excluded from federal medical programs for various reasons, including health care fraud, overcharging patients, charging for unnecessary services, failure to pay student loans, felony convictions, or failing to take corrective measures earlier prescribed by a federal agency.

So far, Kramer said, 45 states and the District of Columbia have provided him with lists of Medicaid-excluded providers, and others are in the process of doing so. South Dakota has so far been the only state to claim records on doctors excluded from Medicaid are not public record, Kramer said.

Assistant Attorney General Daniel Todd, director of the South Dakota DSS Division of Legal Services, in a July 25 written reply, told Kramer “the information you request is not a public record in the state of South Dakota.”

Kramer finds that hard to believe. He said he has made multiple requests asking Todd why the information is not public record, but he has not yet received a satisfactory reply.

“If South Dakota provided the specific statutory citation that permits them to withhold the records, I would go away,” Kramer wrote in a recent email. “If they don’t, I will pursue.”

Todd supplied Kramer with a link to federal websites listing exclusions from Medicaid, but Kramer said those sites require searches by name and don’t automatically output a state-specific list of the names of doctors who have been excluded from Medicaid programs since 2010.

Other states have provided either documents listing the requested doctors’ names or Internet links where the names of those excluded from the program can be found.

In answer to a similar request from The Daily Republic, Todd cited state codified law 1-27-1.5, which has 27 subparagraphs listing exemptions from the state’s open-records laws. The exemption list does include “Medical records, including all records of drug or alcohol testing, treatment, or counseling, other than records of births and deaths,” but does not specifically mention Medicaid or physicians’ Medicaid status.

Kramer said he has not received the same reply from Todd, but he wants a more targeted response. He wants to know specifically what law excludes the information from public access.

Kramer is attempting to appeal the state’s withholding of the information to the South Dakota Office of Hearing Examiners. That’s the office designated to handle disputes over government records.

“South Dakota is absolutely the only state that has refused to provide these records, saying that it’s not a public record,” Kramer said. “There are a few states who have not provided them yet — one being New York — but they tell me they’re working on it.”

Kramer said the public needs to know about bad actors in the medical professions and this bureaucratic tangle is preventing the public from getting information it needs to protect itself.

“It’s about truth, justice and the American Way,” he said. “Ever since I was a kid I always had the idea that if I ever saw someone taking a purse from an old lady that I’d run and tackle the guy. I guess this website is a substitute for that, and I want to be effective.”

Kramer said the abuses he has uncovered have rankled him, especially in cases where physicians were busted for running “pill mills” and indiscriminately prescribing medications without a prior examination.  

“I’m nobody,” he said, “but I looked at these prescription numbers and said, what the heck is this?”

One Florida psychiatrist, Fernando Mendez-Villamil, was charged with writing 96,000 prescriptions over a two-year period to Medicaid patients. In 2009 alone, state records show Mendez-Villamil prescribed millions of dollars in antipsychotic meds.

Kramer is focused on a system loophole as part of his research. Providers who are excluded from Medicaid, which is managed by the states, are not automatically excluded from Medicare, a federal-run health insurance program for older and other qualifying Americans.

The Medicaid-Medicare issue attracted the attention of Sen. Chuck Grassley, R-Iowa. Grassley sent letters to all states requesting information similar to that being sought by Kramer. While Grassley did not identify Mendez-Villamil by name in his request letter, he cited the case generally as an example of something he wants to see curbed. Grassley wants confirmation that providers excluded from Medicaid programs are also being excluded from Medicare.

In a letter to Grassley, South Dakota Medicaid Director Kirby Stone has referred the senator to a federal database listing such exclusions.

That database, however, may only be searched by individual name. It does not automatically display the names of all sanctioned individuals or physicians in a given state.

Stone wrote that four South Dakota doctors have been terminated from Medicaid for cause, but he did not list their names. Stone also noted that providers sometimes terminate their connections to Medicaid voluntarily or because their licenses expire.

Kramer has enlisted the help of state Rep. Stace Nelson, R-Fulton, in his quest for the information.

Nelson, who is also a candidate for U.S. Senate, said the names Kramer wants should be public information.

“We’ve got a huge problem in South Dakota,” Nelson said. “We’ve got too many bureaucrats who are acting as gatekeepers. They’re not saying they don’t have the information. They just don’t want to release it.”

Nelson said he tried to help Kramer by contacting Jim Fry, director of the Legislative Research Council. Fry has since resigned. Nelson said he made repeated requests to the LRC but has not followed up recently.

“The bottom line is it appeared to be a legitimate request, and they never denied they had the records,” Nelson said. “No exemptions were specified and it appeared they were stonewalling for the sake of stonewalling.”

“If they’re releasing this information to the federal government, how is this information not public information to begin with?” Nelson asked. 

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