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Insurance
Fraud
In 2002, a Pennsylvania mental health provider agreed to pay $7.8 million (6.3
million) to settle criminal charges of false and fraudulent Medicare and Medicaid
insurance claims.
In 2000, Tennessee psychiatrist Jan A. Mayer was sentenced to three years in
prison and ordered to pay nearly $400,000 in restitution for his role in a scheme
to submit false bills to several government and private insurance agencies,
including bills for 24 hours of work during periods that he was vacationing
in Puerto Rico.
In 2000, in Mainz, Germany, psychiatrist Otto Benkert was sentenced to 11 months
in jail, suspended in lieu of probation, fined $176,171 and ordered to pay $704,683
in compensation for defrauding the university where he worked as the Chief of
Psychiatry.
In 1997, a Brisbane, Australia psychiatrist, Mary Jane Ditton, was convicted
of making false claims to Medicare, after systematically doubling the amount
of time she spent in consultation with patients. She was ordered to repay nearly
$35,000 and sentenced to 2 1/2 years in jail.
Between 1994 and 1998, scandal rocked Japan after the discovery that private
psychiatric hospitals were forcibly incarcerating and illegally restraining
patients, falsifying medical records, and inflating the numbers of doctors and
nurses in the facilities to obtain more money from the government. Several psychiatrists
were convicted of fraud and jailed.
Drug Fraud Drug abuse and drug fraud are common occurrences in the psychiatric
system. According to one veteran California health care fraud investigator,
and as seen in these following examples, one of the simplest ways to detect
fraud is to look for excessive prescribing rates among psychiatrists.
In May 2004, New York psychiatrist David Roemer was sentenced after pleading
guilty to a charge of felony conspiracy in a prescription drug scam that defrauded
the government�s insurance scheme and flooded the streets with millions of dollars
in highly addictive narcotics and other drugs, including the tranquilizer Xanax.
Roemer worked with four accomplices who recruited Medicaid insurance recipients
from the streets and drug treatment centers. On the ride to Roemer�s office,
the recruits were given money and told what drugs to ask for. Roemer then �sold�
them the
prescriptions, which they then took to pharmacies and filled using their Medicaid
benefits. The pills were handed over to the recruiters who sold them on the
black market. Roemer was sentenced to 10 1/2 years in prison and ordered to
pay more than $340,000 in restitution to the Medicaid program.
�There are few things more pathetic than a crooked doctor, particularly one
who uses his office like a drug dealership,� New York Attorney General Dennis
Vacco said during a press conference announcing the conviction and sentencing
of psychiatrist Priyakant S. Doshi. In 1996, Doshi was sentenced up to 7 1/2
years in jail for indiscriminately dispensing drugs, �with no intent to determine
if his patients really needed them.�
When Texas psychiatrist Frank Dunn was convicted in October 1992 for illegally
distributing prescription drugs, Assistant District Attorney Susan Patterson
told the court, �He is a drug dealer of the highest caliber � the pinnacle of
the pyramid.� Drug abusers knew Dunn as �Dr. Feel Good.� He was sentenced to
16 years in prison and fined $10,000.
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