Fraud committed by psychiatrists
Authors: S S Sharfstein
Journal: American Journal of Psychiatry (1985)

E conomic issues dominate current discussions of psychiatric service needs and the distribution of care. Almost two-thirds of the financing for psychiatric care comes from the government, and approximately 10% of all expenditures under Medicaid are for psychiatric services. At the same time it has been amply documented that there is an undenfinancing of private office psychiatric care by third parties, especially the government, and that private medical and surgical care receives a much higher proportion of its reimbursement through third-party systems (1). Fraudulent claims submitted to third parties and abusive practices compromise the integrity of the entire medical enterprise. Psychiatrists must fulfill their ethical obligations not only to individual patients but also to the fiscal intermediaries who provide support for care from pooled community resources. In this light, the report by Geis and associates in this issue of the Journal must be taken very seriously. It points out that a disproportionate number of psychiatrists, compared with other physicians, are suspended from the Medicare and Medicaid programs because of fraud and abuse. In the mid 1 970s, when fraudulent practice in residential treatment centers for children came to light in the CHAMPUS program, psychiatric benefits were nearly cut in half. Only the timely interposition of peer review provided confidence to the government that the profession could closely monitor care and prevent fraud and abuse (2). Geis and associates indicate that psychiatrists are perhaps “easy targets,” since it is easier to monitor time inflation and the use of nonphysician personnel than “procedures” used by other medical specialists. Perhaps the auditors of government programs monitor and review psychiatrists disproportionately more than other physicians, as a result making psychiatrists more frequent targets for investigation. If that is the case-the report does not shed light on this question-it could lead to greater reluctance on the part of psychiatrists to treat the government-insured poor in private office practice. For physicians who practice with integrity (the vast majority), being so closely monitored undermines the effectiveness of care. Also, a major issue not considered in Geis and associates’ report is the need to encourage greaten participation by private psychiatrists in treating the poor (3). As the authors state, “Nonetheless, what is actually known and what is believed about fraud against government medical benefit programs by psychiatrists reflects unfavorably on the practice of psychiatry.” It should be noted that the American Psychiatric Association, through its Ethics and Peer Review Committees and its contracts with CHAMPUS, the Federal Employees Health Benefits Program, and 24 commercial carriers, has probably been the most active medical specialty society in pressing for accountability and quality care. APA emphasizes and publicizes these efforts as a necessary counterweight to stigmatizing notions which imply that psychiatric care is ineffective and/or a rip-off. Professionals can monitor themselves much more effectively than a third panty such as government can, and the extent to which we do so will prevent unwarranted and clinically damaging intrusions into our offices and files. Confidence in psychiatric care begins with confidence in the integrity of the providers and the willingness of professional peers to be held accountable to each other.