U.S. — Mental Health Fraud Exacts High Human and Financial Costs

Mom's pills by Robbie Sproule

From the American Journal of Managed Care opinion piece:

…Consider a couple of illustrative cases. A CMHC operator in Louisiana and a CMHC patient recruiter in Texas were imprisoned for their roles in a multimillion-dollar Medicare fraud scheme. In Baton Rouge the recruiter invited beneficiaries to attend PHP programs knowing the patients didn’t need psychotherapy and kept them at facilities as long as possible without triggering Medicare audits. Staff also altered records to make it look as if patients received therapy when they didn’t.

In Houston the recruiter invited beneficiaries to attend a PHP in exchange for cash payments. The 2 fraudsters received prison sentences of 90 months and 60 months, respectively. Three companies involved in the case collectively filed more than $258 million in inappropriate Medicare claims. Seventeen people were convicted, including the psychiatrist co-owner of the Louisiana CMHC and the Houston facility, who was sent to prison.

In another case in Houston, 3 individuals earned 12, 20 and 45 years in prison and were made to pay more than $100 million in restitution for their roles in a $158-million PHP scam. Beneficiaries watched television all day, patients with dementia couldn’t understand or were not capable of participating in therapy they allegedly received, and others never were admitted to hospital. The scheme included kickbacks to recruiters and group home operators for bringing ineligible Medicare beneficiaries to the organization.

As mental health services expand in the wake of the Affordable Care Act, rooting out fraud, waste and abuse in this arena becomes even more critical. Even though we’ve improved coverage, the actual provision of services remains difficult to measure. Confidentiality issues and the social stigma and secrecy that surround mental health further discourage patients and families from speaking up and complaining…

Read the full article here:
http://www.ajmc.com/contributor/andria-jacobs-rn-ms-cen-cphq/2016/03/mental-health-fraud-exacts-high-human-and-financial-costs#sthash.lReWnSp6.dpuf

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