The Wall Street Journal reported December 26, 2018 that 141 psychiatric hospitals across the U.S. remained fully accredited despite serious safety violations between 2014 and 2015, including the death, abuse or sexual assault of patients.
A lot of money is at stake: Medicare payments to inpatient psychiatric facilities reached $4.5 billion in 2017, growing an average of 1% each year since 2006.
Evidence repeatedly shows that patients are at risk in for-profit psychiatric facilities that lack effective oversight.
The largest U.S. psychiatric hospital chain, owned by Universal Health Services (UHS) has approximately 200 behavioral facilities in the U.S. alone. As of September 2018, UHS had set aside $90 million in reserves to potentially settle a Federal Department of Justice (DOJ) investigation into its billing practices involving 30 behavioral facilities and UHS headquarters. UHS continues to come under scrutiny for patient abuse, yet is allowed to purchase or build more psychiatric hospitals.
Another major behavioral hospital chain is owned by Acadia Healthcare, which has 586 mental health and substance abuse facilities nationwide. Both these chains capture billions of dollars in Medicaid and Medicare funding in an overall $220 billion-a-year U.S. behavioral health industry.
The potential for fraud in these two chains alone could be upwards of $230 million to $460 million. Over the past decade, UHS has already accounted for about $37 million in False Claims Act settlements and fines.
Psychiatric Times estimates that between 10 and 20 percent of state mental health funds are lost to fraud, waste, and excess profits to for-profit managed care companies—representing $5 billion-$10 billion.
The National Health Care Anti-Fraud Association (NHCAA) says that individual victims of health care fraud are sadly easy to find. These are people who are exploited and subjected to unnecessary or unsafe medical procedures, or whose medical records are compromised or whose legitimate insurance information is used to submit falsified claims.
Many health care fraud investigators believe mental health caregivers, such as psychiatrists and psychologists, have the worst fraud record of all medical disciplines.
What is needed is legislation that provides not only more effective oversight but also stronger accountability measures: criminal and civil penalties, removal from Medicare and Medicaid programs and their funding, and hospital closure where systemic abuse is found.
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