Fraud and abuse in psychiatric practice.
A consensus has not yet been reached on definitions of fraud and abuse, particularly the latter. Further, the terms tend to be linked routinely by federal agencies, although abuse is generally understood to relate to inappropriate and fraud to illegal practices. These definitional problems make it difficult to determine what constitutes fraudulent or abusive practice in psychiatry. The authors provide hypothetical examples relevant to psychiatry, noting that in many cases it is still impossible to determine at what point a practice becomes inappropriate or illegal. Criteria must be developed by claims review systems, ethics committees, and PSROs; all those in the mental health field should devote serious attention to these issues.
D003415:Crime; D004992:Ethics, Medical; D005607:Fraud; D006296:Health Services; D006300:Health Services Misuse; D007358:Insurance, Psychiatric; D011366:Professional Review Organizations; D011570:Psychiatry / Q000592:standards*; D014481:United States