I recall one man who put a sign on his lawn and in his office that he was “Dr.” when, in fact, he had a master’s degree. This fraud was included on his letterhead, where he put a number that appeared to any unaware person to be a licensed number. It was not his license at all but a number for some other activity in which he engaged.

The licensing board had repeatedly warned him to rectify the situation, but he didn’t because he knew that there wasn’t enough staff to go out and check on his actions. Everyone thought he was a medical doctor or a psychiatrist in the town where he practiced.

Another large practice had secretaries administering psychological test materials for which they neither had experience nor degrees. Ethically, they should not have had access to these materials.

Everyone who came to the practice was put through a series of computerized tests, and their insurance was charged for all of this unnecessary testing. The practice reaped millions of dollars a year, and nothing was ever done to the man who owned it. He even charged insurance for missed therapy sessions, which is outright insurance fraud.

The secretary administered a basic IQ test at another office, not a therapy office, but offering a different service. The testing material was kept on her desk. Nothing was ever done about this, either because the man in charge was not a licensed healthcare professional, and he was never investigated for this practice.

Anyone wishing to check on a licensed mental health counselor can go to the state–by–state listing on the Internet. For licensed psychologists there is also a similar listing. Psychiatrists are listed as medical doctors.

Then, there are those who call themselves doctors who may have degrees in things other than healthcare-related specialties, such as administration or even history. The term is not carefully regulated and may be used by so many people that it is, and can be, intended to deceive.

There are also those who catfish on the Internet and present themselves as something other than who they truly are. I am speaking about authors who delve into the intimate, personal lives of young people and then use this material to write books. Is it ethical? Do these people really respond to anything regarding ethics? I find it absolutely untenable.

What about those who “graduated” from schools that have been shut down because they were nothing but diploma mills? Yes, they are out there, and when they write their website profiles, they carefully exclude any mention of the school and say they have “studied” topics such as neurobiology or science.

Taking one course could be seen as “studying.” Are they expert in any area? Deceit and deception are their watchwords, and you are their intended victims. Bestseller means nothing. Please do not be misled by this term.

Defrauding Patients and Insurance

I’ve written about this before, but the material requires updating because these practices continue to emerge and must be dealt with legally.

Today, we are still confronted by those who would deceive us and by doing so, become extremely wealthy, but the consequences for the people who come to them can be fatal. These individuals sought help after they believed there was no help from traditional sources of medicine or therapy, and they came wanting to believe that these “healers” offered the only hope for these patients.

Now, the curtain is being pulled back, and lawsuits and legal battles are being fought as some people have died. One man has now been charged with more than one incident of manslaughter when he advised someone to stop taking their insulin and instead use his “slapping” therapy. The man died.

Federal charges say a woman from Minnesota sold a fake “microcurrent therapy” device across the country that she said could fix almost any illness or condition but actually burned or hurt people who tried to use it

Not only are these fake healers being uncovered, but those who promote unprofessional therapies that any professional organizations do not recognize are being outed, too. Unfortunately, once their papers were published, too many people readily picked them up and used them as references in their papers.

Can you imagine that up to 10,000 professionally published papers had to be retracted for various forms of data manipulation or outright fraud? This form of publication pollution takes time to discover, but once it is discovered, we know that the damage has been done to too many people.

One form of alleged therapy is conversion therapy, which claims to change people’s sexual orientation from homosexual to heterosexual. Every professional organization has debunked this, and it is no longer viewed as valid by anyone but the practitioners who make money from it. How many people have been psychologically damaged by this therapy that perpetuates feelings of shame?

There are no magic healers out there, but they will continue presenting themselves as such, and it is up to consumers to check everyone’s background carefully. Criminals are always looking for new ways to make money and unfortunate, hopeless people on whom to prey.

The post Psychotherapy Shouldn’t Be Fatal, But Lethal Fraud Still Exists appeared first on Medika Life.

“Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services. Individuals with a behavioral health disorder also utilize significant health care services — nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved individuals with a mental disorder, substance abuse problem, or both.”

Eighty-two million-plus people are served by Medicaid each year. If the need is so great, and it is admittedly the case, what is the reason reimbursement rates for Medicaid patients are so low? Don’t low-income individuals or families deserve to be on equal footing in terms of any healthcare with other families who live above the poverty line? States determine who is eligible for the program, and it can be quite wide-ranging and daunting for any individual to figure out what services they have available to them.

What are the current rates in a state like New York or New Jersey for Medicaid reimbursement for mental health services? Figuring out the payments and co-pay isn’t for the faint of heart. As usual, it’s convoluted and requires billing experience, and that’s the reason that career may receive a bump in persons needed.

Medicare pays covered providers about $77.81 for 30 minutes of individual therapy. Not everyone will use that 90832 code. Higher billing rates are a prime issue here and . billing is left to ethical and legal issues. But Medicaid, for the same session, could pay less than $60.

In some cases, previously, the rate was about $50. When many psychotherapists are charging over $100/hr (and in NYC it could be $300/hr.), who is going to accept a Medicaid patient? Therapists have a right not to accept patients and some will do so if the individual doesn’t have “adequate” reimbursement.

It is a disturbing fact of life that, when potential patients call for a therapy appointment, they will often indicate they have insurance coverage. How demeaning for them. The bottom line is that money can be a major issue for care. One woman, who indicated she believed every therapist was qualified, wrote a book on her experiences.

I heard of a case where a therapist, in a large practice run by a psychiatrist, was in a session with a Medicaid patient when the door suddenly burst open. The psychiatrist told the patient to get out and never come back again.

It was an unwritten rule in the practice that Medicaid patients would not receive services. The therapist, not knowing of this practice, had agreed to see the patient, a young man with HIV and prior drug addiction.

One of the major problems that lead to quality differences must be considered. Anyone who has a thriving practice and sees a few pro bono cases, may not accept Medicaid cases. Who will accept them? Money is a great temptation and knavery waits for its opportunity.

Although we do hear of occasional whistleblowers reporting unethical and fraudulent Medicaid cases, many who receive the care either don’t realize the care is by unqualified persons or would be reluctant to report. Just as there are pill mills, there are Medicaid/Medicare mills run by unscrupulous therapists who reap the profits and care little about anything other than filling appointments.

Some practices book patients for multiple sessions, one after the other, for additional therapy during one day with other therapists. Ever notice those “hot boxes” outside the doorways to offices?

I also heard of a master’s-level licensed therapist who accepted Medicaid and provided therapy for children who were sexually abused. After more than four years of therapy with one boy, the therapist, when questioned, admitted that he had not received any advanced training. Where was management in this case? He works at a local mental health center.

The boy was not making progress in this therapy, but the mother felt she had no recourse to obtain therapy with someone else. Everyone she called refused services once she indicated it was a Medicaid case.

But it’s not only in psychotherapy that the lower-income patients receive care from an unlicensed, neophyte, or inadequately trained individuals. A highly experienced ENT physician admitted to me that he was no longer doing surgery because “I get about $3 for an operation that costs $1,500,” he said. I think he was engaging in hyperbole because I’m sure Medicaid pays more than that for ENT surgeries.

How Medicaid can be made more equitable in terms of reimbursement is a question for everyone, but especially the politicians in each state. Services to anyone must be done on need, not payments, but that’s where it stands now. As they say, money talks. Does your state offer charity care for those in need?

The post Inadequate or Unqualified Therapy Because of Low Medicaid Reimbursement? appeared first on Medika Life.