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Watchdog warns Congress to be on lookout for fraud in $50 billion psychiatric-behavioral market

The Citizens Commission on Human Rights called for increased monitoring of psychiatric hospitals to ensure patient safety.

Jeff Lagasse, Associate Editor

A citizens watchdog group and two U.S. Congressmen are cautioning about the potential for fraud, abuse and wasteful spending in behavioral healthcare.

Thousands of U.S. state legislators have been put on notice about potential patient abuse and fraud in the for-profit behavioral system that is costing taxpayers an estimated $50 billion a year.
Of this amount, the inpatient behavioral market, which largely provides psychotropic drugs and electroshock treatment as its mainstay treatments, costs around $20 billion, according to the mental health industry watchdog Citizens Commission on Human Rights.

[Also: Mental health emergency department visits outpace non-psychiatric episodes, study says]

The group sent letters to legislators in states that have for-profit psychiatric hospital chains after a series of recent media reports exposed potential systemic abuse in the mental health sector.

Earlier this year two former U.S. Congressmen -- Rep. Ronnie Shows of Mississippi and Rep. Bart Stupak of Michigan -- wrote about the need to eliminate wasteful spending, particularly noting the for-profit behavioral hospital chains. Shows pointed out that "when it comes to healthcare fraud, mental health and drug treatment programs are some of the worst actors."

[Also: GOP bill aims to add beds for psychiatric treatment but makes funding scarce for patients]

Stupak encouraged the Centers for Medicare and Medicaid Services to review the Medicare and Medicaid charges made by such facilities.

Among the alleged abuses are allegations that the for-profit behavioral sector can use involuntary commitment laws, such as the Baker Act in Florida, to detain patients longer in order to milk their insurance, according to the group.

Another lucrative field is substance abuse treatment, which has escalated with the opioid addiction problem in the U.S. Addiction psychiatry usually treats substance abusers with prescription drugs. For opioid addiction, buprenorphine or a combination of buprenorphine and naloxone is often prescribed. Abuse of this prescription drug has now become an epidemic.

The mental health sector provides for clinics to dispense buprenorphine in much the same way methadone clinics were established, CCHR said, but it is more lucrative as there are fewer costs. Many doctors charge $200 to $300 monthly, per patient, for a five-to-10 minute checkup to renew the prescription. There is a financial windfall in this market, as buprenorphine and its maintenance creates a disincentive to taper patients off the drug due to its potential to generate income.

Detoxing from buprenorphine dependence can cost $5,000 because it takes four to five months, incorporating about 10 different drugs to detox the patient successfully.

CCHR has called for increased monitoring of the facilities and financial audits of them to ensure patient safety and urged hospital staff, former staff and families of patients to report abuse or potential fraudulent billing to it so that the information can be turned over to the proper authorities.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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