Mental Heath Professionals

There are several schemes that while they are not unique to the field of mental health, they tend to be more common in this field. The topic of healthcare fraud is rather large, and there are several different schemes that are all prosecuted by the federal government.

One scheme that is common with mental health is the act of billing for services not rendered. There is a particular problem with many inpatient and outpatient facilities that treat individuals with mental health problems. 

This act involves billing for treatments of patients when there was no treatment given, and it is common within this field because often health care professionals think they may be able to get away with it.

Investigations into this are usually done by the DOJ and the Attorney General’s Office and prosecuted under the False Claims Act, Health Care Fraud Statute and other fraud crimes. The investigation will look to see what you billed your mental health patients for and try and figure out if there was ever any work actually done.

For the act of billing for services not rendered, you should speak to an attorney about what practices you perform and how you keep a detailed record. It is important to always keep a record of any billed activities, so you can defend against these fraud claims.

Another common scheme is billing for non-covered services as a covered service. One of the most common instances covered under this scheme is billing for group therapy when there is no group therapy going on. Often providers will say there is group therapy for activities like bingo or watching a movie. 

If you are caught billing Medicare and Medicaid for these types of activities, you may see criminal liability under the False Claims Act.

The investigation into this will usually involve questioning of patients and providers to try and see what activities were going on during the purported billable activity. There is a good chance, that there will be some evidence of what activities were done, so it is important to not bill for improper activities.

You should contact an attorney to make sure you are in compliance with the healthcare laws and if you are under investigation. The investigation process into these charges can be long and cumbersome, so having an attorney to speed up the process can really make a difference. 

Also if you are charged, an attorney can find out what evidence the prosecutor has to be able to defend against the evidence.

One dangerous and publicized scheme is overprescribing and providing services that are medically unnecessary. This is a crime that is common among psychiatrists who prescribe mental health drugs. There is a tendency in the field to overprescribe tends to be publicized.

If you are found to be overprescribing, you may be charged with fraud based claims like Health Care Fraud, but you may also face charges if anyone is hurt by your overprescribing. Sometimes these cases come forward due to a patient being harmed or killed by their prescription, which could result in much higher charges against you.

The investigation into providing unnecessary services looks into individual cases to try and assess the needs of the patients that you saw and try and find if you were meeting their needs. It is hard to tell what the needs may have been, but if there is a clear pattern of overprescribing, it may be easy for the prosecutor to tell.

It is important that you retain an attorney during the investigation process – especially if you are charged. An experienced attorney will know the standards involved in mental health patients being overprescribed and getting unnecessary services. 

In the defense against these charges, one of the most common defenses is that you acted within your discretion with your determination of prescribing or providing certain services.