From: hounddog23x@gmail.com   
      
   Mental health scams target Medicare and Medicaid    
      
      
   Programs spend billions to treat mental illness, making them ripe for fraud in   
   this sector    
   September 28, 2014 | By Jane Antonio    
   Fraud involving Medicare and Medicaid mental health benefits has been "a   
   special enforcement problem that stretches back decades," according to former   
   Department of Health and Human Services Inspector General Richard P. Kusserow.   
   "Many healthcare fraud    
   investigators believe mental health caregivers, such as psychiatrists and   
   psychologists, have the worst fraud record of all medical disciplines,"   
   Kusserow wrote. That belief is largely based on numbers of prescriptions for   
   narcotics and exploitation of    
   patients diagnosed with mental illness or Alzheimer's disease.    
      
   One fraud hotspot is community mental health centers (CMHCs) that offer   
   partial psychiatric hospitalization programs. In Medicaid, there's been "an   
   explosion of fraud in community-based treatments," including billing for   
   services not rendered, services    
   provided by unlicensed staff or services tainted by kickbacks, according to   
   Assistant U.S. Attorney Ted Radway.    
      
   The Medicare Strike Force made arrests for significant CMHC fraud involving   
   programs serving about 25,000 beneficiaries, Kusserow noted. Yet just one out   
   of nine Medicare Audit Contractors reviewed last year by the Office of   
   Inspector General worked to    
   thwart CMHC fraud, Kusserow noted. This finding led the agency to recommend   
   increased controls and enforcement in this area.    
      
      
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   A recent case involved Louisiana psychiatrist Zahid Imran who was sent to   
   prison for his role in a Medicare scam involving partial hospitalization   
   services. Imran admitted patients who didn't need partial hospitalization and   
   then recertified their    
   appropriateness for the program to keep the Medicare reimbursement flowing.   
   Imran's crimes were part of a $258 million fraud scheme in which 17 people   
   were convicted, including therapists, marketers, administrators, and owners of   
   facilities in two states.   
    Perpetrators paid recruiters to round up patients and altered documentation   
   to make it look like they received treatment.      
      
   Mental health fraud is more pervasive in Medicaid, Kusserow wrote, since   
   Medicaid and the states provide more funding to this area than Medicare. Last   
   year, for example, New Mexico investigated 15 of its largest mental healthcare   
   providers who were    
   suspected of cheating Medicaid out of $36 million in three years.      
      
   For more:    
   - read Kusserow's commentary    
      
      
   http://www.fiercehealthpayer.com/antifraud/story/mental-health-s   
   ams-target-medicare-and-medicaid/2014-09-28   
      
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