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Related Experiment Videos

Fraud and abuse in psychiatric practice.

O B Towery, S S Sharfstein

    The American Journal of Psychiatry
    |January 1, 1978
    PubMed
    Summary

    Defining fraud and abuse in psychiatry remains challenging due to unclear terminology. Clearer criteria are needed to distinguish inappropriate from illegal practices in mental health services.

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    Area of Science:

    • Psychiatry
    • Medical Ethics
    • Healthcare Law

    Background:

    • Lack of consensus on definitions for fraud and abuse in healthcare.
    • Federal agencies often link these terms, causing confusion.
    • Distinguishing between inappropriate (abuse) and illegal (fraud) practices is difficult.

    Purpose of the Study:

    • To explore the definitional challenges of fraud and abuse in psychiatric practice.
    • To highlight the difficulties in identifying fraudulent or abusive behaviors in mental health.
    • To emphasize the need for clear criteria in psychiatric practice.

    Main Methods:

    • Analysis of existing definitions and terminology related to fraud and abuse.
    • Presentation of hypothetical examples within psychiatric practice.
    • Discussion of the implications for claims review and ethics committees.

    Main Results:

    • Significant ambiguity exists in defining fraud and abuse in psychiatry.
    • Hypothetical examples illustrate the difficulty in pinpointing when a practice becomes inappropriate or illegal.
    • Current frameworks are insufficient for clear determination.

    Conclusions:

    • Urgent need for consensus on definitions of fraud and abuse in psychiatry.
    • Development of specific criteria by claims review systems, ethics committees, and PSROs is essential.
    • Mental health professionals must actively address these definitional issues.

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