Peculating Psychologists: Fraud and Abuse Against Medicaid

• 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
• ISSN: 0735-7028; 1939-1323
• DOI: 10.1037/0735-7028.16.6.823

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.