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IMPORTANT
FACTS
1. Mentally troubled
persons and those living in residential psychiatric facilities are easy targets
for exploitation: fraud, assault and sexual and/or financial abuse.
2. Psychiatrists, psychologists,
psychotherapists and their hospitals must be made fully accountable for their
funding, practices and treatments �and their results.
3. Any psychiatrist or
psychologist facing professional board investigation for sexual abuse of a client
should always be suspected of fraudulent billing practices.
It will always be left to agencies external to the mental health system to
police it. Psychiatrists and psychologists will not change direction, any more
than they did after a decade of exposure of massive fraud in private for-profit
hospitals in the 1990s.
CHAPTER
FIVE What Should Be Done?
A Medicare Fraud and Abuse Training Manual advises examining mental health services
for fraud and abuse. The reasons given include: patients trust their therapist/counselor;
mentally ill persons are easy targets for exploitation; and residents living
in residential psychiatric facilities are at risk for exploitation by health
care providers.
According to the Arkansas Attorney General, �Physical abuse or neglect is any
action or failure to act that causes unreasonable suffering, misery, injury
or harm to a resident � from striking or sexually assaulting a patient to withholding
necessary and adequate food, physical care or medical attention.
�Financial abuse includes the misuse of a resident�s trust funds to pay for
nursing home services already being paid for by the Medicaid [insurance] program
or for uses of a patient�s funds not authorized by either the resident or resident�s
guardian, trustee, administrator, etc.�
Other things to watch for include misrepresenting the length of a �therapy
session� (billing for a one-hour rate when the patient only received 20 minutes);
billing for individual consultation or therapy when the patient was part of
�group therapy�; billing for patients that cannot possibly benefit from �therapy�
(such as comatose patients); and billing for outside contractors (therapists)
not covered by the facility's insurance. Drug prescription records should also
be monitored. Any
psychiatrist or psychologist facing professional board investigation for sexual
abuse of a client should always be suspected of fraudulent billing practices.
It will always be left to agencies external to the mental health system to
police it. Psychiatrists and psychologists will not change direction, any more
than they did after a decade of exposure of massive fraud in private for-profit
hospitals in the 1990s. Author Joe Sharkey states, �... As anyone who watches
television and reads the papers is aware, psychiatric hospitals, psychiatric
wings of general hospitals, and addiction treatment centers are still eagerly
trolling for customers who have insurance.�
According to the California Department of Mental Health Medical Evaluation
Field Manual(1991)� which CCHR assisted in introducing��Mental health professionals
� have a professional and a legal obligation to recognize the presence of physical
disease in their patients � Physical diseases may cause a patient�s mental disorder
[or] may worsen a mental disorder.�
In fact, up to 40% of psychiatric facility admissions would be unnecessary if
patients were first properly medically examined. This represents enormous potential
savings in terms of dollars and suffering.
Ultimately, psychiatrists, psychologists, psychotherapists and their hospitals
must be made fully accountable for their funding, practices and treatments,
and their results, or lack thereof. This includes criminal acts that should
be dealt with only through the courts, not medical tribunals.
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