Heads up on health-care fraud

I READ WITH INTEREST the article by Kathryn Foxhall "How would your practice records look to the FBI?" I was audited by the Medicare carrier for services I provided in 1991­92. I was fortunate in that the judge who eventually heard my appeal found I had done no overtesting or overbilling.

I hate to sound paranoid, but I believe the carriers are looking for techniques that can be used to limit the availability of psychology services. Many psychologists think if they only bill a small number of Medicare claims they will not come to the attention of the carrier and, therefore, they are safe. But this cowering behind a small number of billings misses two important points:

  • As the population ages, Medicare will become an increasingly important insurance, and any provider of health services will eventually be billing large numbers of Medicare claims.

  • If the Medicare carrier's inappropriate techniques are not strongly opposed in every case in which they are used, then they will be applied to all psychologists for the purpose of limiting access to mental health services.

In my case there were lots of irregularities and unfair tactics by the Medicare carrier. I would be eager to share my knowledge of what to look for and how to survive when this happens to others (and, believe me, it could be you next!).

Cornelius, N.C.

I WAS PLEASED TO READ THE January article on health-care fraud. However, I am frustrated by the tendency of some in our profession to demonize government investigators and the insurance industry. We must be open in recognizing that there are psychologists who defraud the system and we can do more as a profession to weed out those who malign the field.

I would like to see APA take the lead in supporting vigorous enforcement of health-care laws and actively educate members on standards of ethical practice. Ultimately, fraud and abuse hurt our patients, the profession, and the taxpayers. By not aggressively addressing these issues in our field, we demean the profession and we invite tighter restrictions from managed care as well as overzealous government intervention. As one psychologist who filed and won a false claims lawsuit against an institution, I can tell you that health-care fraud is alive and well in our field.


Where's my old Monitor?

I JUST RECEIVED MY JANUARY Monitor. The new format is appalling. A once easily scanned and respectable newspaper is now a pretentious "wannabe" journal. The newspaper format allowed the picking of articles of interest by a quick scan of headlines and relatively little page turning. If the current format represents savings in production cost, ignore my complaint. If it represents an increase in production cost, it is a waste of the dues we pay.

Wichita, Kan.

Heed this warning

PAGE 42 OF THE NEWLY PACKAGED (thank goodness) January Monitor contains a warning for psychologists that we ought to heed. Dr. Newman suggests that wounded managed-care companies will be contracting with Internet-based companies to provide health services and information online.

One key reason that the managed-care industry made the inroads it did was the head-in-the-sand response of health-care providers. Once again, the experts in this industry are taking advantage of opportunities that emerge in the marketplace. At first, escalating costs in health care presented the industry with an opportunity to offer alternatives and garner huge profits in the process. Now that opposing forces have coalesced to put the industry on the defensive, managed care has determined that the Internet offers a way not to only stay in business but to further solidify its position in this robust economy.

APA, through Dr. Newman's column, correctly detects the danger. It is incumbent on APA to take a leadership position among the national health-care associations and unite them in an effort to prevent managed-care companies and Internet-based ventures from partnering to provide health-care information and services in the electronic media.

Efforts must be made in Congress and the federal courts to challenge this latest tactic because such partnerships will generate activities that cross state lines. Also, state licensing authorities will lose their power to regulate health-care services and thus protect citizens within their borders.

I urge readers to write APA and ask that it attend to this issue now while there is still time to prevent further erosion of the professions by corporatized health care.

Greenwich, Conn.

Prescription privileges

FIRST OF ALL, KUDOS ON THE new format for the Monitor on Psychology. It is now much easier to read, absorb and store the information it contains.

I was, however, struck by the contrast between the two points made in the January 2000 issue. The first involves one of the goals that the new APA president, Pat DeLeon, PhD, JD, has set for APA--that of prescription privileges for psychologists. DeLeon feels that prescription authority is being used "inappropriately," and enabling psychologists to prescribe will benefit patients because they will only use medication when necessary. The second is the article "Psychotherapy is cost-effective," by Rebecca Clay. This piece discusses the effectiveness of psychotherapy. It seems to me that expending APA's efforts to gain prescription privileges for psychologists will only place us in the same predicament that many psychiatrists are now finding themselves--being forced to prescribe medication, and being unable to engage in our undisputed specialty of psychotherapy.

Brooklyn, N.Y.

Get started on the master's issue

IN HIS FIRST "PRESIDENT'S COLUMN" (January issue), Pat DeLeon discusses psychology's need to "end the confusion over the master's issue." The Council of Applied Master's Programs in Psychology (CAMPP) has worked since 1986 to provide standards of education and training for applied master's-level programs. Currently, CAMPP has 65 member programs and will hold its Third National Conference on Master's Psy- chology in June. We will certainly address DeLeon's concern for challenging "our collective appreciation...." We hope to go beyond that by developing a plan to lay the "master's issue" to a well-deserved rest.

We hope that the conference will include APA supporters of master's-level psychology, but would also welcome those opposed to the integration of master's-level psychology into our nation's mental health network. Those of us familiar with the quality and competence of our graduates need to hear and understand the rational argument for excluding master's-level psychologists from the delivery of much-needed mental health services. We're quite familiar with the version that goes "We've always done it that way" and we reject that position as untenable in today's world.

I believe that people of good will can work creatively to rise above past difficulties and differences. I challenge APA and professional psychology in general to live up to our discipline's potential.

Kansas City, Mo.
Chair, CAMPP

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Further Reading

All letters to the editor must be 250 words or fewer. Mail them to APA Monitor on Psychology, 750 First St., N.E., Washington, DC 20002-4242, or e-mail them by e-mail.