No psychiatrist in Illinois – or Texas, Florida and California, for that matter – has come close to Dr. Michael Reinstein in prescribing the antipsychotic drug clozapine to public aid patients, Medicaid records show.
At the request of ProPublica and the Tribune, Columbia University researcher Dr. Mark Olfson reviewed Reinstein's prescribing numbers. In 2005, the year Reinstein wrote the most clozapine prescriptions, Olfson said the number was 70 times greater than what would be expected of even a busy psychiatrist.
"A concern that arises when you have someone seeing an inordinate number of patients is: Do they have time to care for people?" said Olfson, who specializes in psychiatric practices.
Reinstein said he had not seen Olfson's analysis but disagreed with the findings.
Besides clozapine, Reinstein tops the charts in Illinois in prescribing two other common antipsychotics, Seroquel and Haldol, Medicaid records show.
Medicaid paid out $55 million over the last five years for Reinstein's bills, prescriptions and orders for emergency care. He also treats patients covered by Medicare, but that agency declined to release Reinstein's billing data.
In an interview, Reinstein disputed state Medicaid's prescribing figures. He said the state tends to overcount and he recently lodged a complaint about that with Medicaid. Agency officials would not say whether they are following up but did note that pharmacists -- not doctors -- report the prescriber's name, potentially creating errors for any physician.
Reinstein also said the state has counted his partners' services and prescriptions as his own. But state officials said audits have not turned up such double-counting.
The huge prescribing numbers have not gone unnoticed by regulators. Twice the state has tried to exclude Reinstein from getting reimbursement through Medicaid, but both efforts failed.
In a 1992 case, a Medicaid audit found about $95,000 in improper bills, said John Allen, inspector general of the Illinois Department of Healthcare and Family Services. A re-audit brought the repayment amount below the threshold for termination.
"There's always one guy you just can't seem to get your finger on," Allen said.
Medicaid has assigned specialized nurse consultants to scrutinize Reinstein's care in recent years. They have found problems with patient diagnoses, transfers to psychiatric hospitals and communication with medical doctors. The reviews can lead to tough sanctions but in each case did not.