Peculating Psychologists: Fraud and Abuse Against Medicaid

Fraud and abuse by providers of Medicaid services remain a largely unexplored area of scientific inquiry. This study presents information on psychologists who have been either criminally or administratively sanctioned for violations of laws governing the Medicaid program. Mental health practitioners...

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Bibliographic Details
Published in:Professional psychology, research and practice research and practice, 1985-12, Vol.16 (6), p.823-832
Main Authors: GEIS, GOLBERT, PONTELL, HENRY N, KEENAN, CONSTANCE, ROSOFF, STEPHEN M, O'BRIEN, MARY JANE, JESILOW, PAUL D
Format: Article
Language:English
Subjects:
Biological and medical sciences
Crime
Government Programs
Health Insurance
Health staff related problems. Vocational training
Human
Medical sciences
Professional Ethics
Psychologists
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychotherapist Attitudes
Social psychiatry. Ethnopsychiatry
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Summary:Fraud and abuse by providers of Medicaid services remain a largely unexplored area of scientific inquiry. This study presents information on psychologists who have been either criminally or administratively sanctioned for violations of laws governing the Medicaid program. Mental health practitioners are disproportionately sanctioned compared to their numbers in the program, a situation at least partly due to the fact that they bill according to time spent with patients, making them easier enforcement targets. Interviews with 8 sanctioned psychologists and 40 state and federal officials involved in administrative and enforcement activities revealed that sanctioned psychologists were commonly charged with filing false claims, felt they were treated unfairly by the system, and resented the low reimbursement rates and paperwork involved with Medicaid. Almost all violators strongly denied personal blame for their behavior. These and related findings are discussed within the context of increased official scrutiny of professionals who participate in government medical benefit programs.
ISSN:0735-7028
1939-1323
DOI:10.1037/0735-7028.16.6.823