How Our Government Helps Drug-Dealing Doctors Kill Us

madinamerica
Lawrence Kelmenson, MD October 21, 2018
 
Psychiatry and Pain Management’s soaring profits since 1990 were fed by a unique combination of favorable circumstances never before seen: First, they’re paid mostly by federal funds. These include Medicaid, Medicare, and tax subsidies for employer-paid healthcare. But unlike other federally subsidized industries, health industry goods and services are covered by insurance, so high costs don’t deter client use of them. Just imagine all the fine food and posh restaurants we would access if we had hunger insurance that paid for them.

Mental health and pain treaters have advantages over other industries that rely on insurance payments: Medicare and Medicaid, being federally funded, are able to spend endless public money with few restrictions on coverage, regardless of cost. For example, Medicare costs jumped after a 2008 law raised mental health reimbursement from 50% to 80%.1 Private health insurers tried to rein in rising mental health costs, but were blocked by 1996,2 2008, and 20103 parity laws that forbade mental healthcare limits, copays, deductibles, or certification requirements from being greater than for physical care. This is part of why private insurance is now so costly.

To tap into this endless money, the pain and ‘mental illness’ fields made use of another advantage: Unlike events covered by other types of insurance, an illness is an arbitrary concept. Doctors can thus broaden its definition in order to broaden their domain: It can be a subjective physical perception with no clear or treatable source. For example, chronic pain became an illness. Illnesses do not even need to be physical: Painful thoughts and feelings, and kids acting like kids, also became illnesses. This was endorsed by a 1992 law4 that granted funds for services for the ‘one quarter who will suffer from mental disorders’, and for biomedically-focused mental illness research to be done at the NIH.

So, unlike other insurers that can verify house fires, car wrecks, or death, health insurers can’t verify mental illness or pain. Unlike other MDs, psychiatrists and pain doctors can invent infinite chronic (and thus lucrative) illnesses. Each client can be labeled with many different ones; there’s no limit. And each illness can justify a doctor’s luring the patient into lifelong addiction to euphoria-giving pills.

These MDs can also pad profits by putting clients on disability: Clients will then return regularly/eternally to prove ongoing disability, to ensure that their SSD checks and food/housing/healthcare assistance continue. Since they won’t work, they’ll have the time (and health insurance) to do so. A 1984 law5 made adult disability approval hinge on subjective functional impairment instead of objective disease evidence; this made mental illness (or chronic pain) easier to get SSD for. In 1991,6 the Social Security administration made child disability also hinge on functionality instead of illness proof. Child SSI cases rose five-fold soon after, mostly for mental illness.7 So illness-creators opened doors to disability benefits as well as insurance cash; that’s convenient, since their addictive ‘meds’ make it hard to work.

Two 1990 laws8 9 specified depression, ADHD, etc.to be valid causes of disability (before then, schizophrenia was the only ‘mental illness’ considered disabling). This further eased access to SSD/SSI funds. These laws also rewarded these illnesses by making life-easing accommodations available to those who ‘have’ them. For example, Billy prefers to play video games rather than do homework. By getting him labeled ADHD, his busy parents and teachers won’t have to struggle to teach him good work habits, since he’ll now be given less schoolwork (he’ll also be drugged into submission, so he won’t need to be raised). And his label may qualify his family for SSI, Medicaid, and other benefits.

400 million addictive prescriptions are filled yearly.10 It’s caused so much addiction and overdosing, including among kids who steal their parents’ pills, that the lifespans of white Americans have dropped steadily (they use 2.5 times as many psych11 and opioid12 ‘meds’ as non-whites). Then a 2000 law13 authorized doctors to treat the addictions they caused with yet more opioids (suboxone, or prison heroin). It’s such blatant drug-dealing that this law had to be enacted to make it legal (it circumvented a 1914 law14 that criminalized the prescribing of opiates to maintain addicts’ addictions). Suboxone is often peddled at drug rehabs, where clients thus score rather than quit drugs. Since the 2008 parity law made insurers cover treatment for addiction the same as for physical illness, these rehabs make a killing.

Mental health treaters capitalized on all these favors to become our most costly healthcare sector15 and a major cause of healthcare becoming our government’s top expense and top tax subsidy. Costs of other government programs also spiked, due to mental health, pain, and addiction treaters baiting and trapping millions into reliance on Social Security and other benefits. Since 2016, Congress has had to divert funds from the SS retirement to the SS disability trust fund,16 since the latter couldn’t keep up with all its mental illness and chronic pain claimants (its main recipients17). Businesses cut full-time workers in order to avoid paying their costly healthcare as is required by law. This drove yet more people to seek federal benefits. Nearly a fourth of Americans are on Medicaid now.

Psych drug and opioid prescribers are bankrupting us and exploding our debt. We spend more on healthcare and its addictive pills than all other nations, yet are still pounded by propaganda about “millions suffering needlessly from untreated mental illness.” Things will only get worse; many more mental health laws are on the way. 18 19 20 21 22 23 24 25 26
Deja Vu

Something similar actually did occur before: The British East India Company, aided by England’s parliament which invested in it, bailed it out, and made laws giving it monopolies, dominated trade in the East in the 1700s. It helped spread British colonialism there. In the 1800s, it profited greatly by growing opium in India and selling it in China. This hurt China’s economy by siphoning its silver and turning industrious Chinese people into idle, unproductive addicts. Its emperor finally halted opium imports after his son (China’s prince) died of an overdose (as did our “Prince”). The BEIC reacted by conquering, with British assistance, all Chinese ports and nearby areas, in order to ensure continued opium selling. This began what China calls its “century of humiliation” in which a great empire was brought to its knees and subjugated by England, France, and Japan.27

Are we at the start of our own lost century, with psych pill and opioid dispensers taking on the BEIC’s role? Like our drug-dealing doctors, it succeeded largely due to close alliance and support from its government every step of the way. The only difference is: Our own healers and leaders are killing us!


Show 27 footnotes

Previous articleMr. Rogers, Trauma-Informed Care, and the Limits of Information
Next articleNew Report Points to Gaps in the Evidence for Pediatric Bipolar Disorder
Lawrence Kelmenson, MD

Lawrence Kelmenson has practiced psychiatry for 32 years, working with children, adults, and families. He graduated medical school from State University of New York, and completed psychiatric residency training at Cornell. He then became staff psychiatrist, and later medical director, of Craig House Hospital in Beacon, New York until 2000, and has since conducted a psychotherapy-based private practice in Cold Spring, New York. 

Thank You Dr Kelmenson and MIA.

Medicare Fails To Recover Hundreds of Millions of Dollars In Lab Overcharges

Kaiser Health News
Fred Schulte December 15, 2017

Five years ago, Companion DX Reference Lab hoped to cash in on cutting-edge genetic tests paid for by Medicare.

The Houston lab marketed a test to assess how a person’s genes affect tolerance for drugs such as opiates used to treat chronic pain. It also ran DNA tests to help treat cancer and urine screens to monitor drug abuse.

But the lab went bust last year after Medicare ordered it to repay more than $16 million for genetic tests health officials said were not needed.

Companion Dx is one of at least six clinical labs mired in bankruptcy court after Medicare alleged they improperly billed the government for unnecessary urine, genetic or heart disease tests expected to cause hundreds of millions dollars in losses to taxpayers, an investigation by Kaiser Health News found.

KHN INVESTIGATION

Liquid Gold: Pain Doctors Soak Up Profits By Screening Urine For Drugs

As the nation’s bill for drug and genetic tests has climbed to an estimated $8.5 billion a year, there’s mounting suspicion among health insurers that some testing may do more to boost profit margins than help treat patients.

Medicare has slashed fees for urine tests and tightened coverage of some genetic screens, which can cost Medicare $1,000 or more per person. Private insurers, who mostly have paid these bills without question, also are taking a more penetrating look at spending on the controversial lab work.

Yet, getting these firms to repay Medicare and private insurers remains a formidable challenge. While some doctor-owned labs have dodged collection efforts for years, several testing firms deeply in debt to Medicare appear to have few assets to repay overcharges dating back years, court records show.

“Medicare shouldn’t be paying for dubious tests, but the time to catch that is in the very beginning when [labs] are asking for payment,” said Steve Ellis, vice-president of Taxpayers for Common Sense, a budget watchdog group. “They need to increase oversight so the dollars don’t go out the door in the first place.”

Continue Reading.

Thank You Mr Schulte and KHN.

United Healthcare Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim

KHN

By Fred Schulte May 17, 2017

 
The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans.

In a 79-page lawsuit filed in Los Angeles, the Justice Department alleged that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved. The government said it had “conservatively estimated” that the company “knowingly and improperly avoided repaying Medicare” for more than a billion dollars over the course of the decade-long scheme.

“To ensure that the program remains viable for all beneficiaries, the Justice Department remains tireless in its pursuit of Medicare fraud perpetrated by healthcare providers and insurers,” said acting U.S. Attorney Sandra R. Brown for the Central District of California, in a statement announcing the suit. “The primary goal of publicly funded healthcare programs like Medicare is to provide high-quality medical services to those in need — not to line the pockets of participants willing to abuse the system.”

Tuesday’s filing is the second time that the Justice Department has intervened to support a whistleblower suing UnitedHealth under the federal False Claims Act. Earlier this month, the government joined a similar case brought by California whistleblower James Swoben in 2009. Swoben, a medical data consultant, also alleges that UnitedHealth overbilled Medicare.

The case joined on Tuesday was first filed in 2011 by Benjamin Poehling, a former finance director for the UnitedHealth division that oversees Medicare Advantage Plans. Under the False Claims Act, private parties can sue on behalf of the federal government and receive a share of any money recovered.

UnitedHealth is the nation’s biggest Medicare Advantage operator covering about 3.6 million patients in 2016, when Medicare paid the company $56 billion, according to the complaint.

Medicare Advantage plans are private insurance plans offered as an alternative to traditional fee-for-service option.

Medicare pays the health plans using a complex formula called a risk score, which is supposed to pay higher rates for sicker patients than for people in good health. But waste and overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity concluded that improper payments linked to jacked-up risk scores have cost taxpayers tens of billions of dollars.

Tuesday’s court filing argues that UnitedHealth repeatedly ignored findings from its own auditors that risk scores were often inflated — and warnings by officials from the Centers for Medicare & Medicaid Services (CMS) — that it was responsible for ensuring the billings it submitted were accurate.

UnitedHealth denied wrongdoing and said it would contest the case.

“We are confident our company and our employees complied with the government’s Medicare Advantage program rules, and we have been transparent with CMS about our approach under its unclear policies,” UnitedHealth spokesman Matt Burns said in a statement.

Burns went on to say that the Justice Department “fundamentally misunderstands or is deliberately ignoring how the Medicare Advantage program works. We reject these claims and will contest them vigorously.”

A spokesman for CMS, which has recently faced congressional criticism for lax oversight of the program, declined comment.

Central to the government’s case is UnitedHealth’s aggressive effort, starting in 2005, to review millions of patient records to look for missed revenue. These reviews often uncovered payment errors, sometimes too much and sometimes too little. The Justice Department contends that UnitedHealth typically notified Medicare only when it was owed money.

UnitedHealth “turned a blind eye to the negative results of those reviews showing hundreds of thousands of unsupported diagnoses that it had previously submitted to Medicare, according to the suit.

Justice lawyers also argue that UnitedHealth executives knew as far back as 2007 that they could not produce medical records to validate about 1 in 3 medical conditions Medicare paid UnitedHealth’s California plans to cover. In 2009, federal auditors found about half the diagnoses were invalid at one of its plans.

The lawsuit cites more than a dozen examples of undocumented medical conditions, from chronic hepatitis to spinal cord injuries. At one medical group, auditors reviewed records of 126 patients diagnosed with spinal injuries. Only two were verified, according to the complaint.

The Justice Department contends that invalid diagnoses can cause huge losses to Medicare. For instance, UnitedHealth allegedly failed to notify the government of at least 100,000 diagnoses it knew were unsupported based on reviews in 2011 and 2012. Those cases alone generated $190 million in overpayments, according to the suit.

While Medicare Advantage has grown in popularity and now treats nearly 1 in 3 elderly and disabled Medicare patients, its inner workings have remained largely opaque.

CMS officials for years have refused to make public financial audits of Medicare Advantage insurers, even as they have released similar reviews of payments made to doctors, hospitals and other medical suppliers participating in traditional Medicare.

But Medicare Advantage audits obtained by the Center for Public Integrity through a court order in a Freedom of Information Act lawsuit show that payment errors — typically overpayments — are common.

All but two of 37 Medicare Advantage plans examined in a 2007 audit were overpaid — often by thousands of dollars per patient. Overall, just 60 percent of the medical conditions health plans were paid to cover could be verified. The 2007 audits are the only ones that have been made public.

CMS officials are conducting more of these audits, called Risk Adjustment Data Validation, or RADV. But results are years overdue.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Health Industry, Medicare

Tags: Medicare Advantage

fschulte@kff.org | @fredschulte

Tank You Mr Schulte and KHN. 

Medicare Failed To Recover Over $125 Million In Overpayments, Records Show

Kaiser Health News

 
By Fred Schulte January 6, 2017

Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services.

An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit.

But officials never recovered most of that money. Under intense pressure from the health insurance industry, the Centers for Medicare and Medicaid Services quietly backed off their repayment demands and settled the audits in 2012 for just under $3.4 million — shortchanging taxpayers by up to $125 million in possible overcharges just for 2007.

Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 17 million elderly and disabled people — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year. And while the plans generally enjoy strong support in Congress, there are critics.
Read More  

 Thank You Mr Schulte and KHN.

OIG: CMS Made $34.5 Million In Potentially Improper Medicare Payouts To The Incarcerated

$20 trillion in debt and 10 times that much in unfunded liabilities.

Government, when only the best will do.

Office of The Inspector General, Health and Human Services

From the OIG Report

CMS’s policies and procedures did not allow CMS to detect and recoup improper payments on a postpayment basis when CMS’s data systems did not identify a beneficiary as incarcerated at the time that a claim was processed. This nonidentification occurred because CMS turned off its postpayment claims edit. CMS has not taken steps Medicare Payments for Services Rendered to Incarcerated Beneficiaries (A-07-15-01158) iii to determine whether any of the $34,588,984 in potentially improper payments made in CYs 2013 and 2014 should have been denied. 

If you'd rather have the Cliff Notes version,

Fierce Health Payer Anti Fraud

18 U.S. Code § 1031 - Major Fraud Against The United States

Prohibited By Law

cornell law
18 U.S. Code § 1031 - Major fraud against the United States

(a)Whoever knowingly executes, or attempts to execute, any scheme or artifice with the intent—
(1)
to defraud the United States; or
(2)
to obtain money or property by means of false or fraudulent pretenses, representations, or promises,
in any grant, contract, subcontract, subsidy, loan, guarantee, insurance, or other form of Federal assistance, including through the Troubled Asset Relief Program, an economic stimulus, recovery or rescue plan provided by the Government, or the Government’s purchase of any troubled asset as defined in the Emergency Economic Stabilization Act of 2008, or in any procurement of property or services as a prime contractor with the United States or as a subcontractor or supplier on a contract in which there is a prime contract with the United States, if the value of such grant, contract, subcontract, subsidy, loan, guarantee, insurance, or other form of Federal assistance, or any constituent part thereof, is $1,000,000 or more shall, subject to the applicability of subsection (c) of this section, be fined not more than $1,000,000, or imprisoned not more than 10 years, or both.
(b)The fine imposed for an offense under this section may exceed the maximum otherwise provided by law, if such fine does not exceed $5,000,000 and—
(1)
the gross loss to the Government or the gross gain to a defendant is $500,000 or greater; or
(2)
the offense involves a conscious or reckless risk of serious personal injury.
(c)
The maximum fine imposed upon a defendant for a prosecution including a prosecution with multiple counts under this section shall not exceed $10,000,000.
(d)
Nothing in this section shall preclude a court from imposing any other sentences available under this title, including without limitation a fine up to twice the amount of the gross loss or gross gain involved in the offense pursuant to 18 U.S.C. section 3571(d).
(e)In determining the amount of the fine, the court shall consider the factors set forth in 18 U.S.C. sections 3553 and 3572the factors set forth in the guidelines and policy statements of the United States Sentencing Commission, including—
(1)
the need to reflect the seriousness of the offense, including the harm or loss to the victim and the gain to the defendant;
(2)
whether the defendant previously has been fined for a similar offense; and
(3)
any other pertinent equitable considerations.
(f)
A prosecution of an offense under this section may be commenced any time not later than 7 years after the offense is committed, plus any additional time otherwise allowed by law.
(g)
(1)
In special circumstances and in his or her sole discretion, the Attorney General is authorized to make payments from funds appropriated to the Department of Justice to persons who furnish information relating to a possible prosecution under this section. The amount of such payment shall not exceed $250,000. Upon application by the Attorney General, the court may order that the Department shall be reimbursed for a payment from a criminal fine imposed under this section.
(2)An individual is not eligible for such a payment if—
(A)
that individual is an officer or employee of a Government agency who furnishes information or renders service in the performance of official duties;
(B)
that individual failed to furnish the information to the individual’s employer prior to furnishing it to law enforcement authorities, unless the court determines the individual has justifiable reasons for that failure;
(C)
the furnished information is based upon public disclosure of allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or GAO report, hearing, audit or investigation, or from the news media unless the person is the original source of the information. For the purposes of this subsection, “original source” means an individual who has direct and independent knowledge of the information on which the allegations are based and has voluntarily provided the information to the Government; or
(D)
that individual participated in the violation of this section with respect to which such payment would be made.
(3)
The failure of the Attorney General to authorize a payment shall not be subject to judicial review.
(h)Any individual who—
(1)
is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by an employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of a prosecution under this section (including investigation for, initiation of, testimony for, or assistance in such prosecution), and
(2)
was not a participant in the unlawful activity that is the subject of said prosecution, may, in a civil action, obtain all relief necessary to make such individual whole. Such relief shall include reinstatement with the same seniority status such individual would have had but for the discrimination, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorney’s fees.

(Added Pub. L. 100–700, § 2(a), Nov. 19, 1988, 102 Stat. 4631; amended Pub. L. 101–123, § 2(a), Oct. 23, 1989, 103 Stat. 759;Pub. L. 103–322, title XXXIII, § 330002(a), (f), Sept. 13, 1994, 108 Stat. 2140; Pub. L. 111–21, § 2(d), May 20, 2009, 123 Stat. 1618.)

Thank You Cornell Law

18 U.S. Code § 371 - Conspiracy To Commit Offense Or To Defraud United States

Continuing with our series on The Actual Laws being violated by Psychiatry:

No one can legally charge money to sell Homicide.

18 U.S. Code § 371 - Conspiracy to commit offense or to defraud United States

If two or more persons conspire either to commit any offense against the United States, or to defraud the United States, or any agency thereof in any manner or for any purpose, and one or more of such persons do any act to effect the object of the conspiracy, each shall be fined under this title or imprisoned not more than five years, or both.

If, however, the offense, the commission of which is the object of the conspiracy, is a misdemeanor only, the punishment for such conspiracy shall not exceed the maximum punishment provided for such misdemeanor.
(June 25, 1948, ch. 645, 62 Stat. 701; Pub. L. 103–322, title XXXIII, § 330016(1)(L), Sept. 13, 1994, 108 Stat. 2147.)


Thank You Cornell Law

of Related interest:

18C95

FierceHealthPayer Anti Fraud: This Week's Headlines

fiercehealthpayerantifraud

HHS misses key opportunities for improper payment recovery

May 16, 2016

While it generally complied with federal improper payment reporting requirements, the Department of Health and Human Services fell short in several key areas, according to an independent audit conducted by Ernst & Young LLP.

OIG to physicians: Be careful whom you do business with

May 16, 2016

In a new "Eye on Enforcement" video, the Office of Inspector General warns physicians to be wary of taking payments from other providers, highlighting a kickback concern the government has targeted over the last several years.

Feds probe relationship between drugmakers, pharmacy benefit managers

May 12, 2016

Federal prosecutors are investigating contracts between three pharmaceutical companies and unnamed pharmacy-benefit managers, an indication the federal government is increasing its scrutiny of potential False Claims Act violations within the agreements, according to the Wall Street Journal.

Medicare contractors relying more on data analytics to investigate fraud

May 10, 2016

Although the number of fraud and abuse investigations initiated by Medicare benefit integrity contractors declined between 2012 and 2013, contractors leaned heavily on predictive analytics to identify fraudulent billing, according to a report released by the Office of Inspector General.

Senate report reignites concerns about physician-owned distributorships

May 10, 2016

Surgeons who have a financial interest in medical device companies are far more likely to perform certain surgeries, according to an updated report that calls for increased scrutiny of the financial arrangements on physician-owned distributorships by the Senate Finance Committee.

MORE NEWS

Psychology's Ongoing Credibility Crisis

Scientific American
New studies have intensified the debate over psychology’s “reproducibility" problems.

• By John Horgan on March 7, 2016

Psychology’s current reproducibility crisis would not have surprised William James, who once fretted that psychology might never transcend its “confused and imperfect state.” Photo of William James via Wikimedia Commons.

It’s a tough time to be a young psychologist. This thought keeps occurring to me as we search for a new psychology professor at my school, Stevens Institute of Technology. When I meet candidates, I have to ask about their field’s replication—and credibility—crisis.

I feel as though I’m pressing them on some sordid personal matter, like whether alcoholism runs in their families, but the topic is unavoidable. Last summer, a group called the “Open Science Collaboration” reported inScience that it had replicated fewer than half of 100 studies published in major psychology journals.

The New York Times declared in a front-page story that the report “confirmed the worst fears of scientists who have long worried that [psychology] needed a strong correction. The vetted studies were considered part of the core knowledge by which scientists understand the dynamics of personality, relationships, learning and memory. Therapists and educators rely on such findings to help guide decisions, and the fact that so many of the studies were called into question could sow doubt in the scientific underpinnings of their work.”

The crisis keeps generating headlines. On Friday, a group of four prominent psychologists led by Daniel Gilbert of Harvard claimed in Science that last year’s Open Collaboration study was statistically flawed and did not prove its claim that “the reproducibility of psychological science is low.” “Indeed,” Gilbert and his co-authors state, “the data are consistent with the opposite conclusion, namely, that the reproducibility of psychological science is quite high.”

In a rebuttal, 44 authors involved in the Open Science Collaboration countered that the “very optimistic assessment” of Gilbert’s group “is limited by statistical misconceptions and by causal inferences from selectively interpreted, correlational data.”

The exchange, Benedict Carey notes in the Times, “is likely to feed an already lively debate about how best to conduct and evaluate so-called replication projects of studies.” That’s too cheery an assessment. The exchange reveals that psychologists cannot even agree on basic methods for arriving at “truth,” whatever that is.

It gets worse. Over at Slate, Daniel Engber reports that the influential theory of “ego depletion”—which holds that willpower is a finite resource that diminishes with use--might have been “debunked.”

Roy Baumeister and three other psychologists presented experimental evidence for the theory in a 1998 paper that has been cited more than 3,000 times. The theory has supposedly been corroborated by hundreds of other studies, and it underpins the 2011 bestseller Willpower: Rediscovering the Greatest Human Strength, by Baumeister and journalist John Tierney.

But a study of ego depletion involving “more than 2,000 subjects tested at two-dozen different labs on several continents,” Engber reports, found “exactly nothing. A zero-effect for ego depletion: No sign that the human will works as it’s been described, or that these hundreds of studies amount to very much at all.” The new study is scheduled for publication next month in Perspectives on Psychological Science.

Spelling out the disturbing implications, Engber notes that the ego-depletion effect “has been recreated in hundreds of different ways, and the underlying concept has been verified via meta-analysis. It’s not some crazy new idea, wobbling on a pile of flimsy data; it’s a sturdy edifice of knowledge, built over many years from solid bricks. And yet, it now appears that ego depletion could be completely bogus, that its foundation might be made of rotted-out materials. That means an entire field of study—and significant portions of certain scientists’ careers—could be resting on a false premise. If something this well-established could fall apart, then what’s next?”

Good question, over which all young psychologists are no doubt agonizing. To cheer themselves, they might consider the following four points:

First, there’s nothing new about psychology’s credibility crisis. More than a century ago, William James worried that the field he helped create might never transcend its “confused and imperfect state.”

Second, all scientific fields struggle with replication issues. Behavioral genetics and psychiatry are arguably much less credible than psychology, and string and multiverse theorists don’t even have empirical results to replicate!

Third, psychologists are still doing important, empirically sound work. Two who recently spoke at my school are Sheldon Solomon, co-creator of terror-management theory, which predicts how fear of death affects us; and Philip Tetlock, leader of a study on “superforecasters,” ordinary people who do a better job than many so-called experts at predicting social phenomena.

Fourth, psychology is arguably healthier than many other fields precisely because psychologists are energetically exposing its weaknesses and seeking ways to overcome them.
I look forward to discussing these issues with the young psychologists visiting my school.

Further Reading:
Meta-Post: Horgan Posts on Brain and Mind Science.
Meta-Post: Horgan Posts on Antidepressants, Brain Implants, Psychedelics, Meditation and Other Therapies for Mental Illness.
A Dig Through Old Files Reminds Me Why I’m So Critical of Science.


Thank You Mr Horgan and Scientific American.

" the report “confirmed the worst fears of scientists who have long worried that [psychology] needed a strong correction."

Semi private rooms at Club Fed would be the Perfect place to start correcting it.

Psychiatrists And Psychologists Not Reliable Expert Witnesses

Us Title 18 Part 1 Chapter 19 Sec. 371 Conspiracy To Defraud The United States: 5 years

Us Title 18 Part 1 Chapter 47 Sec. 1031 Major Fraud Against The United States: 10 years

Us Title 18 Part 1 Chapter 47 Sec. 1035 False Statements: 5 years

Us Title 18 Part 1 Chapter 63 Sec. 1341 Mail Fraud: Frauds and Swindles: 20 years

Us Title 18 Part 1 Chapter 63 Sec. 1347 Health Care Fraud: 10 years

Us Title 18 Part 1 Chapter 63 Sec. 1349 Attempt and Conspiracy

Us Title 18 Part 1 Chapter 95 Sec. 1957 Engaging In Monetary Transactions In Property Derived From Specified Unlawful Activity: over $10,000, 10 years

Just the Tip of the Iceberg.

• The Law (13)

Clinicians Ensnared In Multi-Million Dollar Fraud Schemes

fiercehealthpayer antifraud
February 16, 2016 | By Evan Sweeney

Clinicians across the country are facing fraud charges for multimillion dollar schemes that run the gamut of medical specialties, from obstetrics and gynecology to pain medicine. 

• A Miami physician pleaded guilty last week to a scheme in which Medicare paid out $20 million in fraudulent payments, according to the U.S. Attorney's Office for the Southern District of Florida. Henry Lora, M.D., served as the medical director for a Miami clinic known as Merfi Corporation. Lora and others wrote prescriptions for unnecessary home health services and falsified patient records in exchange for kickbacks. The owner of the clinic was sentenced to nine years in prison in 2014 for her role in the scheme.
• In New Jersey, an obstetrician gynecologist was charged with submitting millions in claims for rectal tests he never performed, according to NJ.com. Prosecutors say Dr. Labib E. Riachi showed a distinct pattern of overbilling, submitting more claims for the test to diagnose fecal incontinence than the next 10 highest billers in the state combined. The complaint also states Riachi billed for more than 500 procedures while he was traveling in Europe, and submitted claims for physical therapy that were never performed by a licensed therapist.  
• A New Mexico pain management physician linked to the death of four patients has pleaded guilty to charges that he wrote unnecessary prescriptions for oxycodone and methadone and billed Medicare and Medicaid for reimbursement, according to the Albuquerque Journal. Officials say Dr. Pawankumar Jain prescribed pain medication to four patients who later died of an overdose, including one in which Jain wrote two prescriptions for more than 500 tablets of methadone.
• A nurse in Pennsylvania was convicted for her role in a scheme that submitted nearly $10 million in fraudulent hospice claims to Medicare. A federal jury convicted Patricia McGill, who served as director of professional services for Home Care Hospice in Philadelphia, of authorizing hospice services for patients who were not medically eligible, according to the U.S. Attorney's Office for the Eastern District of Pennsylvania.

Home health and hospice fraud schemes have been on the radar of federal and state investigators, particularly in the Midwest, where authorities in Detroit and Chicago have targeted home health and hospice fraud. The Office of Inspector General and legislators have highlighted opioid prescribing as a key issue within Medicare Part D spending, while some state enforcement agencies have failed to investigate providers with a long history of overprescribing.

To learn more:
- here's the announcement from the U.S. Attorney's Office for the Southern District of Florida
- read the NJ.com article
- read the Albuquerque Journal article
- here's the announcement from the U.S. Attorney's Office for the Eastern District of Pennsylvania

Related Articles:

Amid a handful of overprescribing convictions, one doctor has a 30-year fraud history
House subcommittee grills OIG, CMS on Part D fraud and abuse
Home health, hospice, laboratory fraud dominate Midwest

Thank You Mr Sweeny and FHPAF.

Consultant Pleads Guilty In $63 Million Dollar Mental Health Scam

fiercehealthpayer antifraud

Scheme involved paying kickbacks through a shell company in exchange for patient referrals

January 19, 2016 | By Evan Sweeney

A consultant who served as a Medicare biller for the now-defunct Greater Miami Behavioral Healthcare Center Inc. has pleaded guilty to her involvement in a $63 million fraud scheme.

Nery Cowan admitted to directing kickback payments to patient brokers through shell companies, including a sham staffing company called HNB-Stell Care Inc. The kickbacks were paid in exchange for patient referrals to the partial hospitalization program that claimed to provide intensive mental health services. Her two co-conspirators in the case have already been sentenced to 16 and nine years in prison. Announcement

Thank You Mr Sweeny and FHP AF.

False Claims Act Recoveries Drop Nearly 40% In 2015

fiercehealthpayer antifraud
Remember whose at 1600 Penn.

The healthcare industry still makes up the majority the government's FCA recoveries, hauling in $1.9 billion

December 7, 2015 | By Evan Sweeney

Not till January 2017, and every second feels like a year.

Following a record-setting 2014, civil False Claims Act (FCA) recoveries saw a 39 percent decline in 2015, dropping to $3.5 billion overall, according tofigures released by the Department of Justice (DOJ).

Federal FCA settlements and judgements from the healthcare industry also dropped slightly from $2.3 billion in 2014 to $1.9 billion in 2015, but the industry still accounted for more than half of all federal FCA recoveries.

Two major cases involving DaVita Healthcare Partners accounted for nearly half of those recoveries. In October 2014, the nation's second-largest dialysis provider agreed to pay $389 million to settle allegations that it paid physicians in exchange for patient referrals.  Months later, DaVita agreed to a $450 million FCA settlement for intentionally wasting larger vials of medicine and billing Medicare for the cost. Although the DOJ declined to intervene in that case, two whistleblowers ultimately won the case after prosecutors alleged that a DaVita witness had provided false testimony and defense attorneys had improperly coached witnesses.

In fact, 2015 was the best year on record for similar whistleblower cases in which the government declined to intervene, according to A. Brian Albritton, an attorney with Phelps Dunbar LLP, as those cases accounted for more than $1.1 billion in recoveries. However, Albritton pointed out that the 737 FCA cases and investigations filed in 2015 represented the lowest total since 2010.

Once again, whistleblowers were a major force in FCA recoveries, accounting for $2.8 billion on 638 lawsuits overall. For example, two whistleblowers initiated a $250 million FCA settlement with 450 hospitals across the country, $216 million of which was recovered during the 2015 fiscal year, according to the DOJ. Kickback settlements involving Adventist Health System, Broward Hospital District and Columbus Regional Healthcare System accounted for more than $200 million.

Pharmaceutical settlements also contributed to the FCA pot, including a $39 million settlement from Daiicki Sankyo and a $54 million joint settlement with AstraZeneca and Cephalon.

For more:
- here's the DOJ announcement
- read the Phelps Dunbar LLP post

Related Articles:
False Claims Act enforcement continues in high gear
Health systems cough up stiff settlements for overpaying docs
Federal False Claims Act scrutiny shows no signs of letting up
Daiichi Sankyo to pay $39M to settle DOJ claims it paid kickbacks to docs
National dialysis provider agrees to pay $450 million settlement for improper billing
DOJ settles with 450 hospitals for $250M over False Claims Act allegations

Thank You Mr Sweeny and FHPAF.