Fraud and Abuse of Government Medical Benefit Programs by Psychiatrists

• NCJ Number: 156060
• Journal: American Journal of Psychiatry Volume: 142 Issue: 2 Dated: (February 1985) Pages: 231-234
• Author(s): G Geis; P Jesilow; H Pontell; M J O'Brien
• Date Published: 1985
• Length: 4 pages
• Grant Number(s): 82-IJ-CX-00035
• Agencies: NIJ-Sponsored
• Publication Type: Survey

Annotation

Government rosters of physicians suspended from Medicare and Medicaid programs due to fraud and abuse indicate that psychiatrists represent a disproportionately large segment of the total.

Abstract

About 8 percent of practicing physicians in the United States are psychiatrists who tend to be more readily apprehended if they violate medical benefit program rules because they charge for time rather than for services. The disproportionate number of sanctioned psychiatrists is underscored when considering physician involvement in medical benefit programs. Medicare severely restricts psychiatric services, and Medicare recipients themselves must pay 50 percent of the costs associated with mental health treatment received on an outpatient basis, up to an annual limit of $500. Medicaid also discriminates against clients who seek long-term and expensive psychiatric care. Given their relatively low rate of participation in medical benefit programs, the proportion of psychiatrists sanctioned for defrauding these programs becomes even more pronounced. The authors speculate on whether psychiatrists actually break the law more often than physicians in other specialties or whether statistics on psychiatrists are purely artifactual. For example, one study indicates that the recorded high rate of psychiatrist apprehension is closely tied to the fact that they are the easiest targets for investigation and apprehension because they bill in terms of time and because the manner in which they spend their time is readily subject to accurate determination. 14 references