Many were skeptical when President Obama claimed that part of the cost of health care reform could be covered by eliminating fraud in the health system.
However, even the President may not realize just how right he was, for there is one particularly pernicious aspect of health care fraud whose extent and social and financial cost truly beggars belief.
The corollary of this hidden travesty is, however, a somewhat sunnier prospect: we are presented with a wonderful opportunity not only to save the tax payer some serious dollars but to make huge strides in reversing the current free-fall of the nation's morale and of its mental and physical health. It is worth then taking a little time to understand it.
Medicaid fraud is easy to recognize as fraud; it is a basic criminality that involves medical people - in the case being examined here, psychiatrists - falsely billing the government for treatment that was never given or for administering "treatment" (usually drugs) that people do not truly need. Action to do something about one aspect of the iniquities that have degraded the health system and ripped off the tax payer has been forthcoming recently from an unexpected quarter, the government, and not surprisingly psychiatrists have been caught in a clampdown on the highly profitable scam of writing fraudulent prescriptions.
For example, the federal government stopped reimbursing a Miami psychiatrist who wrote nearly 97,000 (!) prescriptions to Medicaid patients over a period of 18 months (by my calculations about 180 each and every day), nearly twice the number of the second-highest prescriber in Florida.
In New York last month a psychiatrist and his corporate medical group, Sisck Inc., pleaded guilty to second degree grand larceny for defrauding Medicaid and now psychiatrist Dr. Godfrey Mbonu must repay more than $214,000 to the state and he faces five to 15 years in prison.
Mbonu was caught after an extended investigation conducted by the Attorney General's Medicaid Fraud Control Unit (MFCU), which revealed that from 2003 to 2009, he was involved in the submission of hundreds of claims to New York State's Medicaid program for medical services that he or his medical group never provided. For example, evidence obtained by MFCU showed that Mbonu submitted claims to Medicaid for psychotherapy sessions in New York when he was actually traveling in Nigeria and that he also claimed to have performed in-office psychotherapy sessions when the patient listed in the claim was actually in the hospital.
The examples cited here are just the tip of an iceberg of similar psychiatric fraud, that groups such as the Citizens Commission on Human Rights have labored diligently to expose, amassing over the years a vast amount of evidence. At last it seems their efforts to bring such fraudsters back under the law are bearing fruit, with even the government taking notice and acting to bring justice to an area where it is sorely needed.
Billing the tax payer for treatment one has not administered or administering treatment, almost always in the form of drugs, that the patient does not need so as to rack up a profitable bill are of course immoral and criminal actions,
A person becomes criminal and starts to acquire money dishonestly at the point where he loses his self respect and considers himself no longer able enough to acquire wealth by honest endeavour or to control his own harmful impulses.
The majority of us of course do not descend to this sorry and degraded condition no matter what the provocation but the concern here is that a considerable number of psychiatrists do. Exactly how many remains to be seen but when one factors in the number of members of this one profession already prosecuted for fraud, patient abuse and other crimes, one cannot help but fear a truly thorough investigation will uncover a alarmingly high number.
I use the word "alarming" because in psychiatry we have a profession that purports to have expertise on the human mind and to know what makes man tick: so much so that it has licence to incarcerate and drug its fellow citizens - AND their children - in the name of "treatment" and has government itself as its staunchest ally.
One would expect therefore to see the highest levels of ability and conduct from a profession that truly possessed such knowledge.
Yet in far too many cases we do not. It is time this claim to expertise were examined against the real world: patient recovery, the morale and mental health of the nation and the conduct of members of the profession itself.
I guarantee that should anyone truly get in there and LOOK, rather than taking psychiatry's PR boasts at face value, I won't be the only one using the word "alarming."
In the meantime, let us focus on the extent to which the tax payer has been the victim of fraud by the psycho-pharmacy, for the true scale of the rip-off extends far beyond the theft engineered by the churning out of bogus prescriptions or the submission of false bills.
More on this subject follows in the next article in this series.
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