More Healthcare Insurance Fraud in Connecticut!

My friend, S, shared a story with me the other day of her visit to a LCSW therapist who performs neurofeedback in Ct..

 Ok…interesting enough in itself that the LCSW can charge my friend S’s insurance for neurofeedback as it falls under “20 pass thru sessions” that require little documentation…more interesting is that the LCSW told her she would be billing her insurance company under the DSM code for an “adjustment disorder” — after talking with her for 20 minutes….and even more interesting is, that this LCSW told my friend S. that she would have to bill her insurance for two sessions (each visit), as one session didn’t come close to paying for her $175/hr fee!

I carefully explained to my friend S. how Mental Health Practitioners theoretically “sign a deal with the devil” in accepting insurance coverage, but nevertheless in entering a contract with an insurance company the therapist agrees to accept “the contracted amount ( plus clients copay)….period!  My friend was rather suprised to realize that this is insurance fraud and thought it was “normal” for the LCSW to want to cover her “regular” fee.

Yikes people! Please wake up! Just because it’s only costing you your copay doesn’t mean fraud is ok! Plus…if you have 20 “pass thru” sessions and the therapist bills double for the first 10 …you are screwed on the 11th….in the middle of “the work” and perhaps stuck paying cash, as the LCSW might have difficulty substantiating  further treatment.

Good news is that S. didn’t respond well to the neurofeedback (said she felt very disoriented and dissociative for several hours afterward ), and the LCSW  basically evaded her questions, so she will not be returning for futher “treatment”.

As much as I wanted to ask the therapist’s name and then do some investigation of my own… aka. “set her up” …I did not…but I think about it!

Anthony Maltese DPH “Consultant LCSW” in Connecticut

here is an update to my blog on 11/5/10…the name of “the fox guarding the chicken coop”

For anyone with a Licensing Board complaint at the DPH in Ct. against an LCSW that is having trouble getting the name of the consultant (peer reviewer) from the CT DPH (they continually redacted the info on paperwork I had received via FOIA)….his name likely is Anthony Maltese LCSW. I say “might be”  as they might have another consultant at this point, but in my discussions with the CT DPH they indicated that there are only a couple that they use as it is an unpaid for opinion…and (no suprise) it’s difficult to find someone to review the cases.  As I mentioned previously in this blog…there are no licensing boards in CT. for LCSW’s, MFT’s, LPC’s or LADC’s

There are no Statutes or Laws preventing the CT DPH from providing you with this information!

They just don’t “like to”….aaawww!

Therapists credentials

Read here about Dr. Zoe D. Katze by Steve K.D Eichel Ph.D

…a remarkable story of attaining credentials in the field of psychotherapy

http://www.dreichel.com/Articles/Dr_Zoe.htm

Is your therapist listed here?

Check and see if your therapist is listed on Therapist Ratings!  Or add your opinion and rating of the therapist

http://therapistratings.com/cgi-bin/index.cgi

Some “Therapists don’t want you to get better”

 

http://sinekpartners.typepad.com/refocus/2010/02/your-therapist-doesnt-want-you-to-get-better.html

by Simon Sinek
Therapists don’t want you to get better.
Lawyers don’t want to help you sort out your legal problems.
And consultants don’t want to help you find the quick and effective solution.
It’s not that they don’t care, it’s just that their respective business models don’t encourage
them to help you. Their businesses only grow and they only reap personal rewards if the
engagement is prolonged. The more hours they work, the more money they make. This is the
problem with all professional services. They bill for their time, not for their value.
A therapist that charges $150 per hour can only make more money by raising the rate or working
more hours. And it’s much easier to keep an existing client coming in for more than going
out to find new ones. That’s so much work.
Imagine if professional service firms charged by the value they offered – the actual thing you
want – and not by how long they worked – something you probably don’t even care about
(unless you’re paying for it, of course). If you wanted to get over your anxiety, for example, the
therapist should tell you it will cost $5,000 (or whatever amount their confidence and reputation
would allow) to help you get over your problem whether it took a week or 5 years. Not
only would you be over your anxiety in a few weeks, you’d recommend the therapist to someone
else because they solved your problem. And, in short order, the therapist would make
MUCH more money and work vastly fewer hours. Everyone wins.
If time is the billable variable, then the value is commoditized. If the solution or result is the
thing sold, then efficiency goes up and differentiation sky rockets. If it’s results you’re looking
for then the lawyer, consultant or therapist will quickly get a reputation for getting things done.
The next time someone tries to sell you a “solution” then tells you how much it will cost based
on billable hours, scratch your head and ask, “are you selling me a solution or are you selling
me the time it will take you to find it?”
How they answer will tell you how much they care.

To whomever has the sick mind in Stratford, Ct. …

To whomever it was that decided the place to dispose of two books was on a public street in Startford ,CT. I, and many others, would appreciate if the next time you can at least find a dumpster to dispose of your child pornographic material. I realize you probably were feeling deep shame and disgust when you chose to toss these books out your car window, but you left them where anyone, including an innocent child could find them.
The police were notified, and although they probably won’t be able to track you and your sick mind…please think twice next time!

Mental Health Consumers not protected from Unethical Therapists

What motivation is there for State Boards and regulatory agencies to dole out disciplinary action or revoke/suspend the license of a Mental Health Professional? Putting a therapist “out of business” leads to a decrease in revenue for the State in which they reside. (Yes, in the “end game” this is politics…so it does matter whether your therapist is republican or democrat in the big picture!…it shouldn’t matter!)

Here are a few ways disciplining a Mental Health Professional effects $$$ in State coffers:

The therapist pays for the license, that is revenue to the state

The therapist (supposedly) pays income taxes, that is revenue to the state

The therapist pays for mandatory CEU’s and assuming they take them in State, again more revenue and taxes collected by the State

Every complaint filed takes resources to investigate…a loss of revenue to the State

Lower State revenue and the tax rates generally will go up which means people won’t be able to afford services like therapy…so again…lost revenue

So why does a regulatory agency want to do it’s job in protecting the public from the acts of unethical practitioners? This is it’s job, but it is over-written by $$$ and politics. Is it more important to protect citizens or bring money into State government? I guess it depends which “side you’re on”.

The truth is you are not protected in any way by State Licensing Boards and Regulatory agencies! IMO, they have an agenda to keep a unethical practitioner in business.

Your Therapist is employed by you!

 

Here’s a link to an article by Dr. John Grohol Ph.D on ” shopping” a therapist and the difference between  Degrees various therapists have:  http://psychcentral.com/diff.htm.

Like he reminds us….remember “your therapist works for you” and can be fired!

Part of the article is below.

Distinctions Between Therapist Degrees
By John M. Grohol, Psy.D.
May 12, 1996
Last updated: October 10, 2007

My Opinions | Other People’s Comments

Related article:
How to Choose a Therapist

My Opinions
An Introduction
As managed care continues to make substantial changes in the field of behavioral healthcare, it is important to understand what you are paying for with your healthcare monies. There is a great degree of differences between professional’s degrees in this field, and those differences may impact on the effectiveness and quality of your psychotherapy work.
In nearly every state in the U.S., therapists must be licensed to practice (e.g., receive a fee for services) under specific, protected titles. For instance, the terms “psychologist” and “psychiatrist” are protected legal terms in every state and, when referring to providing clinical services, can only be used by properly licensed professionals. Ideally, such licensure helps to ensure that the professional has passed a minimum set of qualifications via a written examination and that if a problem arises with their provision of professional services, the authorities of that state have some recourse. In the real world, however, bad therapists obtain licensure all the time and the redress procedures for filing a complaint against a therapist nearly always favor the therapist. Nevertheless, when shopping for a therapist, make sure the professional is licensed whenever possible. I wrote for Mental Help Net.)

And yes, you should shop and compare therapists, just like you would in making any important life decision. You will spend a fair amount of your hard-earned money to pay for the therapist’s services (whether it’s done out of pocket or via your insurance/HMO premiums). You deserve to know basic information about the professional you are about to trust your innermost feelings and thoughts to, including their professional background, their educational background, how many years they’ve been practicing, and how much experience they’ve had in helping people with problems similar to your own. The more experience they’ve had and the longer they’ve been in practice are usually two of the best indicators to look for in finding a suitable clinician. A professional, regardless of their educational background, who has had 20 years of therapy experience and has worked with dozens of individuals presenting with problems similar to your own is much more likely to be of help to you than someone with 2 years of experience and you’re the first person they’ve seen with your particular mental health concern. (It makes sense, doesn’t it? The research backs up this view.)

Keep in mind that if you find your first choice in a therapist isn’t working out, give the therapist a pink slip and ask for a referral to one of his or her colleagues. Remember, the therapist works for you. If you don’t feel like you’re clicking after a few sessions, or the therapist isn’t listening to your concerns or providing you with enough feedback in your sessions, let them know. Don’t be afraid to change therapists if your concerns aren’t adequately addressed to your satisfaction.

There are a number of degrees which I didn’t cover in my original writings, but which are included in the other people’s comments section. These degrees/clinicians include licensed professional counselors, marriage and family counselors, and psychiatric nurses, to name a few.

——————————————————————————–

Nurses busted again! Are the professions treated equally?

STATE REGULATIONS APPROVED
ENFORCEMENT ACTIONS — PROFESSIONAL PRACTITIONERS
http://www.ct.gov/dph/lib/dph/communications/rar/pdf/qu_3_10.pdf

This is a compilation of the 3rd Quarter Regulatory Action Report 2010 for the Connecticut Department of Public Health. Again, members of the nursing profession top the list. Why does the CT DPH spend so much time, and resources of the State of Ct. taxpayers focusing on this one group of professionals!? Of 102 total disciplinary actions 66 were against those in the nursing profession…that’s roughly 65%! If they’re chasing nurses this often, it leaves them a much smaller percentage of time and budgeted resources to ensure the public is protected from other health care professionals.

Total Nursing Profession = 66 (APRN 3 + LPN 28 + Nurses Aides 4 + RN 31 = 66)

Total all other health professions = 36

 …of that, 13 were MD’s)

…only 2 were mental health professionals

…only 16 were professionals regulated directly by the Ct DPH…all others are under the jurisdiction of licensing or examining boards

STATE REGULATIONS APPROVED
ENFORCEMENT ACTIONS — PROFESSIONAL PRACTITIONERS

ADVANCED PRACTICAL REGISTERED NURSES 3
BARBERS & HAIRDRESSERS 8
DENTAL HYGIENISTS 2
DENTISTS 1
EMBALMERS 1
EMERGENCY MEDICAL TECHNICIANS 2
LICENSED MASSAGE THERAPISTS 2
LICENSED PRACTICAL NURSES 28
NURSE AIDES 4
PHYSICIANS 13
PROFESSIONAL COUNSELORS 1
PSYCHOLOGISTS 1
RADIOGRAPHERS 1
REGISTERED NURSES 31
VETERINARIANS 4

blue ball machine!

 

for fun! blue ball machine!

http://blueballfixed.ytmnd.com/