Posts Tagged ‘Medicare’

Human Rights Concerns with the Helping Families in Mental Health Crisis Act of 2015

Saturday, July 18th, 2015

Human Rights Concerns with the Helping Families in Mental Health Crisis Act of 2015

Congressional Rep. Tim Murphy (R., PA) originally introduced the Helping Families in Mental Health Crisis Act (H.R.3717) in 2013. Not to be outdone by H.R.6 the 21st Century Cures Act, he has reintroduced it to this year’s Congress as H.R.2646 the Helping Families in Mental Health Crisis Act of 2015.

Rep. Murphy is a psychologist, and a staunch supporter of “mental health care” as defined by the psychiatric and psychological industries; not to mention the pharmaceutical and insurance industries.

Official Title of the Act: “To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.”

The Act creates a new position in the Department of Health and Human Services – an official to be known as the Assistant Secretary for Mental Health and Substance Use Disorders. (As if we need another bureaucracy in the psych industry.)

The Act creates more funding for psych-based “treatments.”

The Act expands the bureaucracy surrounding “parity in mental health and substance use disorder benefits” under Medicare and Medicaid.

The Act provides for grants in early childhood intervention and treatment programs, and specialized preschool and elementary school programs.

The Act provides for grants in “Assisted Outpatient Treatment” programs.

The Act requires states to have a law that enforces court-ordered involuntary mental health treatment for the “mentally disabled” if the state want to receive certain federal funding.

The Act expands mental health training for primary care physicians.

This isn’t even half of the proposed legislation.

The Act spends lots more money on “suicide prevention” all up and down the entire educational chain, from elementary school through college.

The Act establishes an entirely new bureaucracy called the “Interagency Serious Mental Illness Coordinating Committee.”

Of course, the Act also expands the availability of and insurance coverage for psychiatric prescription drugs, as well as lifting limits on Medicare payments for inpatient psychiatric hospital services.

The Act expands the Community Mental Health Care programs.

The Act increases funding for the National Institute of Mental Health.

And even that’s not all the Act does to strengthen the already fraudulent and abusive psychiatric mental health industry.

CCHR Supporters should really consider contacting their Congressmen to express their opinions about this affront to rationality.

Let us know when you contact your Congressmen about this, and any response you may receive.

21st Century Cures Act

Sunday, July 12th, 2015

21st Century Cures Act

H.R.6, the 21st Century Cures Act, is rushing through Congress now. This bill amends the Public Health Service Act to reauthorize the National Institutes of Health (NIH) budget, and to make some major changes in the NIH, the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), Medicare, the Controlled Substances Import and Export Act, and the Department of Health and Human Services.

We are pretty sure that not all of these changes are going to be benign. We invite you to read the Act and read the rebuttal, decide for yourself, and contact your Congressmen now with your personal opinions.

Warning: the text of the Act is difficult to read in the context of the laws it is proposing to change, since it does not print the revisions in line of the original law, as in proposed Missouri legislation for example, but instead just prints the text being removed and the text being inserted.

Here are some salient quotes from the rebuttal:

“The Act is a give-away to the pharmaceutical industry, removing many of the safety mechanisms in place that are supposed to keep the public protected from unsafe drugs and medical devices.”

“The 21st Century Cures Act will diminish another bedrock of modern medicine – informed consent.”

“But if pharmaceuticals are no longer required to have evidence that they improve health outcomes, how are they any better than snake oils? One only needs to look as far as the recent history of psychiatry to see that the line between snake oils and ‘evidence based medicine’ is already woefully thin.”

“The 21st Century Cures Act diminishes the rocks on which modern medicine are based – informed consent, individual body autonomy, the Hippocratic Oath, and basing medicine on scientific evidence.”

Obviously we are not diagnosing or recommending treatments here. We want to alert you to this Congressional action, and make sure you are informed so that you can exercise your own judgment. While sections of this proposed legislation are likely useful, there are other sections that may be damaging in the long term and may be passed into law in haste.

Here is an example of a section called out in the rebuttal (“With the passage of the 21st Century Cures Act, drugs will be rushed to market with little testing required.”):

“SEC. 2022. Accelerated approval development plan. In the case of a drug that the Secretary determines may be eligible for accelerated approval in accordance with subsection (c), the sponsor of such drug may request, at any time after the submission of an application for the investigation of the drug under section 505(i) of this Act or section 351(a)(3) of the Public Health Service Act, that the Secretary agree to an accelerated approval development plan described in paragraph (2).”

This refers to paragraph (2) which describes the use of a “surrogate endpoint” in an accelerated approval development plan. The term “surrogate endpoint” means a marker, such as a laboratory measurement, radiographic image, physical sign, or other measure, that is not itself a direct measurement of clinical benefit. So a result of this could be that clinical trials no longer measure the clinical benefit of a new drug on the fast track to approval, just unspecified changes in various measurements that may, or may not, be beneficial to the patient. This is the kind of change that causes us to question the haste and wisdom of this proposed Act.

Let us know when you contact your Congressmen about this, and any response you may receive.

And read what we have to say about Informed Consent.

Medicare

Wednesday, May 1st, 2013

Medicare

Continuing our discussion of psychiatric fraud (see our recent newsletter on Medicaid), we highly recommend an excellent article on Medicare and Medicaid fraud by Chris Parker in the St. Louis Riverfront Times (RFT) (“Thieves’ Bazaar: Hospitals, doctors and dealers have made Medicare the nation’s sweetest crime”, 4/25/2013).

Medicare is a federal government health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

Following are some quotes and paraphrases from the RFT article.

“Think of the Medicare program as a bank that never bothered to buy a safe. Everyone from HMOs to drug dealers have been caught robbing it time and time again, stealing the kind of money that makes the sequester look like pocket change.”

Since 2007 the federal Health Care Fraud Prevention and Enforcement Action Team (HEAT) has charged 1,480 defendants with $4.8 billion in fraud.

In 2011 Mohammad Khan, administrator of Houston Riverside General Hospital, confessed to federal fraud investigators for enriching the hospital through a kickback scheme, paying “recruiters” $300 a head to bring Medicare patients to Riverside’s six psychiatric clinics.

“They arrived by the van-load for daily therapy sessions they rarely qualified for or received. Medicare picked up the $116 million tab.”

“Kahn ratted out CEO Earnest Gibson III as his co-conspirator. The feds also nabbed Gibson’s 35-year-old son, Earnest IV. He ran one of the psychiatric clinics and was charged with billing nearly $700,000 for care that ‘was not medically necessary and, in some cases, not provided,’ according to prosecutors.”

“Investigators discovered that, since 2005, the hospital had been swindling the feds to the tune of $22 million a year. Kahn pleaded guilty. The two Gibsons and five others await trial on charges of fraud, conspiracy and money laundering.”

Cuban expat Armando Gonzalez started several outpatient psychiatric clinics in Miami with a scheme similar to Riverside’s. “Gonzalez paid assisted-living facilities kickbacks to bus in residents suffering from retardation and dementia. The clinics would then bill Medicare for services the ‘patients’ weren’t eligible for or didn’t receive. By the time the feds started sniffing around in 2008, Gonzalez had already made off with $28 million…He closed shop in Miami, only to reopen in North Carolina. When he was finally arrested last year, Gonzalez was planning to expand into Tennessee.”

In 2010 Frank Walther of the Medicare fraud task force helped take down American Therapeutic, the highest-billing mental-health center in the country. “The company was cycling addicts, alcoholics and Alzheimer patients through its six clinics. Patients’ diagnoses were changed so they would qualify for expensive group therapy.”

In 2011 “Minnesota was pumping up its Medicaid reimbursements to cover losses in a state program that Medicaid doesn’t reach.”

Then there’s the Las Vegas Cocktail, mixing Xanax, Soma and Vicodin for a powerful opiate high. Michigan’s Monroe Pain Center, near the Toledo, Ohio, border, went from seeing 40 patients a day to as many as 250, prescribing 5 million doses of narcotics over two years, defrauding Medicare out of $5.7 million.

New York state centers for people with mental issues were charging the feds $5,000 per day per patient while Arizona only charges $200 a day. New York’s estimated overcharges: $15 billion.


Oh, my! Who’s paying for all this fraud? Medicare and Medicaid are government programs, financed by your tax dollars (and the federal debt.) Can anyone guess why health care costs are so high and continuing to rise?

What shall we do? What do you think? Has your own health insurance cost increased recently? Shall we just let this fraud continue?

These are not purely rhetorical questions. They do have some answers.

You are one of the answers. Contact your local, state and federal officials and representatives; let them know what you think about this situation. Suggest that they find out about all the money wasted on fraudulent and abusive psychiatric mental health care, and recommend that they reduce or eliminate the use of harmful, coercive and abusive psychiatric treatments and psychiatric drugs in favor of non-psychiatric alternatives, so that people with mental trauma can actually be helped rather than harmed.

Forward this newsletter to your family, friends and associates and tell them to subscribe.

More information about psychiatric fraud can be found by clicking here.

By the way, report Medicare fraud here.

Medicaid

Thursday, April 18th, 2013

Medicaid

It’s in the news today, constantly. What is it, and what should we know about it? What’s all this talk about expanding state Medicaid?

Medicaid is a state and federal partnership providing health coverage for people who qualify. Across the U.S. over 62 million people are enrolled in Medicaid, with a total federal plus state budget of $400 billion per year.

The Center for Medicaid and CHIP Services (CMCS) is one of six Centers within the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services (HHS). CMCS serves as the focal point for all national program policies and operations related to Medicaid and the Children’s Health Insurance Program (CHIP).

If you don’t have and are unable to afford health insurance, you and your family may qualify for free or low-cost health insurance coverage through Medicaid.

Each state operates its own Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities. The eligibility rules for Medicaid are different for each state.

Enacted in 1965 through amendments to the Social Security Act, Medicaid is a health and long-term care coverage program that is jointly financed by states and the federal government. Each state establishes and administers its own Medicaid program and determines the type, amount, duration, and scope of services covered within broad federal guidelines. States must cover certain mandatory benefits and may choose to provide other optional benefits.

Federal law also requires states to cover certain mandatory eligibility groups, including qualified parents, children, and pregnant women with low income, as well as older adults and people with disabilities with low income. States have the flexibility to cover other optional eligibility groups and set eligibility criteria within the federal standards.

The Affordable Care Act of 2010 creates a new national Medicaid minimum eligibility level that covers most Americans with household income up to 133 percent of the federal poverty level. This new eligibility requirement is effective January 1, 2014, but individual states may choose to expand their Medicaid coverage before this date. For a household of one person, 133% of the current federal poverty level is an annual income of $15,282 (and add $5,347 for each additional person.)

Medicaid is the single largest payer for mental health services in the United States. Examples of provided mental health services include screening, counseling, therapy, medication management, psychiatric services, licensed clinical social work services, peer supports, and substance abuse treatment.

There is a large and active Medicaid fraud culture, both provider and participant fraud, that wastes billions of dollars per year. For example, estimates range between $2 billion and $4 billion in fraudulent psychiatric drug claims per year nationally. Medicaid spends roughly $25 billion per year on prescription drugs.

Some of the more common provider fraud includes: billing for services when no service was provided; billing for a more expensive treatment or service than was actually provided; billing for unnecessary services; billing for the same service multiple times; receipt of kickbacks; excessive compensation for medical directorships or consultancies; physicians referring patients to obtain services from a Medicaid provider whom the physician or physician’s immediate family member has a financial relationship.

Some of the more common participant fraud includes: signing documentation indicating services were provided when not provided; selling prescription medications obtained through the Medicaid program; forging prescriptions to obtain medications; allowing someone other than the card holder to use a Medicaid card; falsifying information to qualify for Medicaid services.

Of course, CCHR supporters will understand that all psychiatric treatments and drugs are harmful and fraudulently prescribed.

Medicaid is an enormous and complex bureaucracy, making it extremely difficult to distill meaningful statistics across all 50 states and the federal government. Diligent research is required to isolate relevant information.

In Missouri, the Medicaid program is known as MO HealthNet. Of the 6 million people in Missouri, over 1 million are Medicaid recipients. Each year, Missouri Medicaid spends over $8 billion to provide health services. Roughly $6 billion is provided by the federal government, and Missouri contributes another $2 billion per year. $600 million goes toward prescription drugs; $43 million goes toward long term mental health care facilities; roughly $500 million goes toward all mental health services, not including drugs.

Missouri offers home- and community-based programs for developmentally disabled adults and children, provided by the Department of Health and Senior Services or the Department of Mental Health. There have been double-digit increases in yearly Medicaid drug spending since 1995. Psychiatric drugs are among Medicaid’s most costly and commonly prescribed drugs. One-third of seniors and people with disabilities enrolled in Missouri’s Medicaid program are prescribed psychotropic drugs.

What do we think about all this? We don’t necessarily think that Medicaid is a bad idea. We do think that expanding Medicaid without also expanding fraud control is a mistake. We think that expanding Medicaid without reducing or eliminating the use of psychiatric treatments and psychiatric drugs is a mistake. We think there are enough non-psychiatric alternatives so that people with mental trauma can actually be helped rather than harmed.

Write your state legislators and let them know what you think about this. More information about psychiatric fraud can be found by clicking here.

By the way, report Medicaid fraud in Missouri to Missouri Medicaid Fraud & Compliance.

Grassley Pursues Prescription Drug Abuse in Medicaid, Medicare

Thursday, April 12th, 2012

A recent Press Release from U.S. Senator Chuck Grassley (Republican, Iowa) caught our attention (read the March 22, 2012 press release here.)

Here are some choice quotes:

“The Office of National Drug Control Policy describes prescription drug abuse as the nation’s fastest-growing problem, while the Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic.”

“Over prescription of these types of drugs strains the financial viability of the Medicaid and Medicare systems and threatens the health and well-being of the American people.”

“In 2010, I sent a letter to all 50 state Medicaid directors asking them for their top ten prescribers of the top eight most over-prescribed drugs on the market. Many states provided the data I requested, and the statistics were alarming.”

“For example, the top prescriber of antipsychotics in Nevada wrote nearly 6,800 prescriptions for the drugs over 2010 and 2011 – more than ten times some of the other top prescribers identified. For context, no individual prescriber in Colorado wrote more than 2,000 prescriptions for the same drugs over the same period. This single doctor in Nevada accounted for $2.75 million in payments from the Medicaid system.”

As a result of Senator Grassley’s request, a number of states began investigations into possible insurance fraud regarding these massive drug prescriptions: South Carolina, Texas, California, Wisconsin, Tennessee, Nevada, New Hampshire, Minnesota, Kansas, Iowa, and Hawaii.

Do we have to spell out how this kind of drug fraud and abuse raises health care and insurance costs for the rest of us?

Are there any other states that should be conducting these investigations into Medicaid and Medicare fraud? Perhaps your state? Write your state legislators and other officials and encourage them to do so.

Now, aside from plain greed, what is the real problem here?

If you said, “DSM”, take a win. The rest of you need to watch the CCHR video documentary “Diagnostic & Statistical Manual of Mental Disorders – Psychiatry’s Deadliest Scam.” If you would like your own copy of this DVD, become a CCHR St. Louis member today and we’ll mail one to you.

You can also read Sen. Grassley’s press release at PsychSearch.net, and we encourage you to get the latest psych news there as well as from www.CCHRINT.org.

Inspectors ask Congress to regulate psychiatric drugs

Sunday, December 25th, 2011

Just in time for a holiday treat, we read an encouraging article in The Concordia Concordian (Concordia, Lafayette County, Missouri).

This December 7th article reports that the federal government Health and Human Services (HHS) Inspector General Daniel Levinson proposed to Congress that Medicare force nursing homes to pay for drugs prescribed inapproriately.

“Government inspectors told lawmakers Wednesday [12/7/2011] Medicare officials need to do more to stop doctors from prescribing powerful psychiatric drugs to nursing home patients with dementia, an unapproved practice that has flourished despite repeated government warnings.”

It seems these harmful drugs are given to hundreds of thousands of elderly nursing home patients to pacify aggressive behavior related to dementia, in spite of FDA warnings that these drugs increase the risk of death in seniors with dementia.

A report from HHS issued last May found that 83 percent of Medicare claims for antipsychotics were for nursing home residents with dementia, and 14 percent of all nursing home residents were prescribed antipsychotics.

While doctors are allowed to prescribe drugs for such off-label uses, it is illegal for drug companies to promote off-label use. Yet this alarming practice continues to bilk Medicare for unapproved drugs, which is another example of psychiatric fraud.

What is the alternative to psychotropic drugs?

Not only do psychiatrists not understand the cause of any mental disorder, they cannot cure them. Though psychiatry may have given up on effective mental healing, this is fortunately false. Mental problems can be resolved, and without harmful and addictive psychotropic drugs.

The first and most obvious action to take with someone mentally disturbed is to Do No Harm. That means ensuring that they are not subjected to psychiatric treatments that use force and harm in an attempt to control behavior. More than anything, the person needs rest, security, good nutrition, exercise, and attention to the real underlying, possibly undiagnosed, medical problems.

We do understand that a nursing staff faced with a seriously disturbed and irrational resident can become desperate in their attempts to resolve the behavior. The psychiatric industry has suppressed workable methods of helping such individuals.

There are far too many workable non-psychiatric alternatives to list them here. As a brief guide, always help a person with quiet, food, rest, and only if necessary to achieve rest, a mild drug so that he or she can rest properly and sufficiently. Never turn someone who is mentally disturbed over to people who use force, seclusion, or physically damaging practices and “treatments.” Ensure that a full and searching medical examination is conducted to determine any undiagnosed and untreated medical conditions. Always find the cause of the person’s problems. Never be satisfied with a mere explanation of the symptoms.

While sanctioning nursing homes that defraud Medicare is certainly a step in the right direction, there is truly only one way to reform the field of mental health and that is to remove psychiatry’s monopoly of it that has led only to upwardly spiraling mental illness statistics and no cures.

Click here for more information about alternatives to abusive psychiatric drugs and treatments.