Psychiatric Medicaid Fraud

Psychiatric Medicaid Fraud

In an August 28, 2013 decision by the United States Court of Appeals for the Seventh Circuit, the appeals judge held that psychiatrists commit Medicaid fraud when they submit Medicaid claims for off-label prescriptions for psychiatric drugs to children for uses that are not approved by the FDA or supported by certain specific pharmaceutical references.

In the words of the court, “…the federal government generally will not pay for medications prescribed for purposes not approved by the FDA or ‘supported’ by any of several pharmaceutical reference books (called ‘compendia’). …Medicaid can only provide reimbursement for ‘covered outpatient drugs.’ …Covered drugs do not include any drugs ‘used for a medical indication which is not a medically accepted indication.’ …’medically accepted indication’ is a statutorily defined term that refers to a prescription purpose approved by the Food, Drug, and Cosmetic Act…or ‘supported by’…the American Hospital Formulary Service Drug Information, the United States Pharmacopeia Drug Information…and the DRUGDEX Information System.”

Basically, the appeals court reinforced the common-sense position that Medicaid fraud occurs when a doctor submits a Medicaid claim for a prescription written for off-label use, as many psychiatric drugs are prescribed.

The original lawsuit, ex rel Watson v. King-Vassel, was brought under PsychRights’ Medicaid Fraud Initiative Against Psychiatric Drugging of Children & Youth by Dr. Toby Watson, a Wisconsin psychologist, to support the Law Project for Psychiatric Rights‘ effort to try and stop the tremendous harm caused by off-label psychiatric drug prescriptions to poor children on Medicaid for uses that have no recognized scientific support.

Starting on January 1, 2014, all low-income, non-elderly and non-disabled individuals will be eligible for Medicaid, courtesy of the Affordable Care Act. The Federal Government will provide 100% of the cost of newly eligible people between 2014 and 2016, 95% of the costs in 2017, 94% of the costs in 2018, 93% of the costs in 2019, and 90 percent matching for subsequent years. The bottom line — expanding Medicaid in this manner will also expand Medicaid fraud. Ensuring that psychiatric drugs are available for all citizens, access to Community Mental Health Centers is being emphasized.

Need we say that all psychiatric drugs are harmful? Find out why!

Report Medicaid fraud in Missouri to Missouri Medicaid Fraud & Compliance.

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