Medicaid Fraud must be endorsed by the Centers for Medicare and Medicaid; it is the only logical explanation for the massive amount of fraud committed to pay for psychiatric drugs not covered under the Federal Medicaid program due to not being FDA approved, and not being listed in the drug Compendia recognized by Federal programs to qualify for reimbursement. Prescriptions written for drugs prescribed for “physical ailments” will not be filled by a pharmacy unless a person agrees beforehand to pay cash.
The Pharmaceutical Companies have all been criminally prosecuted and heavily fined; but the fines have not served as a deterrent. The illegal behavior of individuals was not punished; so it continues… The fines are just a business expense. This criminal enterprise could not have been successful without enlisting the participation of doctors and pharmacists who illegally cause fraudulent claims to be submitted; and who directly benefit from the payment of the claims. When will the investigation of psychiatric drugs for behavioral and emotional problems used on foster children be focused on doing what is in the children’s best interest? As it is now, the children’s best interest are one of many ‘concerns’ being discussed; but it is apparent to me that it is not the primary concern—according to Ethical Guidelines adopted by Medical Professionals and the Legal mandates which govern the provision of Child Welfare services, the best interests of the child is always supposed to be the primary focus. Instead, discussion is focused on how to train medical professionals to better utilize the existing treatment protocols that are without scientific validity; by monitoring and quantifying the harm (or benefit) experienced by the children being drugged. The primary focus appears to be defending the indefensible, the unethical Standards of Care being used which have necessitated repeated investigations into the harm being caused. These are the standards of care which have, intentionally or not, enabled, and facilitated the generation of enormous corporate profits for the pharmaceutical industry, by defrauding the American people and exploiting vulnerable children on Medicaid .
The treatment protocols used in Standard Practice are, like the psychiatric diagnoses, are based on a consensus of opinions; i.e. consensus is evidence of agreement, not evidence of diagnostic validity. Nonetheless, these standards continue to be widely used and vehemently defended; instead of focusing on the harm caused by them…Professionals using them violate the trust of their patients and the public. But worse that that, they harm their patients by failing to inform them of the risks, and many then medically neglect their patients’ iatrogenic injuries and diseases and even attribute drug-induced disease and dysfunction to the psychiatric diagnosis the drugs are supposedly treating. Ironically, psychiatrists often claim it is their patients who lack insight…
We, as a society, are failing miserably to protect children from being exploited. Poor children on Medicaid, particularly those who have been made Wards of the State, through no fault of their own, are being exploited and treated like a commodity. Foster children are given drugs which cause them to develop diseases and rob them of their innate abilities and their intellect. Some are killed by the treatment they receive. WE THE PEOPLE are paying for this criminal treatment…WE THE PEOPLE have been defrauded in order to fill corporate coffers. It is on WE THE PEOPLE’S collective behalf that social workers and Medical professionals care for the children who are in the foster care system. This exploitation of children will continue until WE THE PEOPLE put a stop to it. The crimes which continue to be committed under the guise of providing ‘necessary medical treatment’ and needed social services to abused and neglected children have been successful due to the willing participation and collaboration of medical professional societies, (the APA and the AACAP) and the public servants working for government agencies (FDA CMS & HHS) This is a massive criminal enterprise that is entrenched within our social service systems and continues to profit from drugging vulnerable children, the elderly, and traumatized veterans.
I am a MadMother. Over the past decade, I have spent hundreds of hours doing research and I am horrified by what I have found. Worst of all, I am ashamed that WE THE PEOPLE have allowed our institutions and government agencies to employ people who recklessly abuse their power and authority, and who seem to have abandoned the ideals and principles upon which the republic was founded.
Ten years before there was any “approved” pediatric use for Johnson and Johnson’s ‘Risperdal,’ it was given to my son. It was prescribed “off label;” an innocuous term for “experimental use.” I believe the term off label is used because it sounds innocuous; it disguises the fact that Human Experimentation using teratogenic drugs is what is being done. Human Experimentation with psychiatric drugs is now embedded within Standard Clinical Practices. I also believe that is why the term neuroleptic has been replaced with the word, ‘antipsychotic.’ The word Neuroleptic is French, a combination of the word neuro, meaning nerve; and the Greek word ‘leptikos’ which means, ‘disposed to take’ equivalent to ‘lēp’ meaning ‘to seize.’ The word neuroleptic actually describes what this class of drug does to the human body. Neuroleptics act on the parasympathetic nervous system; which explains the myriad of negative effects they are known to have. It is why the drugs cause a wide variety of diseases and progressive cognitive and neurological impairments, and it is why they shorten people lives… But then, all substances that cause disease also cause a loss of life…
I want to know why the Department of Justice is not prosecuting the felony crimes committed which harm our Nation’s foster children? Why have no Federal charges been brought against the doctors, psychiatric researchers, and pharmacists who have caused billions of dollars of fraudulent claims to be paid? Why is nothing being done to stop the fraud? Why are false claims still being paid?
From the Law Project for Psychiatric Rights:
“In a surprising action, however, on March 7th, the Department of Justice actively moved to protect alleged defrauding defendants at Steps 2 & 3 by asking the judge to dismiss the ex rel Nicholson case for what appears to be disingenuous reasons.”
“In light of this, PsychRights asked Eric Pruitt, the Assistant United States Attorney who filed the motion to dismiss on behalf of the United States Government, the following questions:
1. Why shouldn’t it be concluded the Department of Justice and CMS are protecting prescribers and pharmacies for their participation in this continuing massive fraudulent scheme?
2. Does CMS take the position that prescriptions not for a medically accepted indication are covered under Medicaid?
3. Is CMS calling the shots on the Department of Justice’s response to the qui tam cases against prescribers and pharmacies for causing and presenting false claims to Medicaid for psychotropic drugs used on children and youth that are not for a medically accepted indication?
4. Do the Department of Justice and CMS consider only the economic point, i.e., the drug companies have deeper pockets, or are they attempting to make an independent judgment that somehow psychiatrists and pharmacists are less culpable for the same fraud?
5. Even if so, why is CMS still paying these false claims on a massive scale?”
Mr. Pruitt declined to answer, saying “We do not comment on pending cases:”
In response, Mr. Gottstein said, “The public is entitled to know the answers to these questions. Obtaining large recoveries from drug companies is an ineffective sanction, because the fraudulent prescribing practices are continuing unabated. It appears the Department of Justice is now actively protecting doctors and pharmacies committing Medicaid Fraud.” Read the press release from PsychRights here.
All due respect to Mr. Pruitt; I am not buying his statement that the failure to answer these questions is due to a policy of not commenting on “pending cases.” The questions posed are relevant to what is happening in every single State in the Nation, (Medicaid fraud continues unabated) not only the two States with pending Qui Tam claims! Mr. Gottstein is right: The American people are entitled to answers! A lame deflection from a Department of Justice employee in response to pertinent questions is not acceptable! Mr. Pruitt you work for the American people and The American people deserve answers not excuses!
In my experience, Medicaid always denied payment for drugs not on the Medicaid “approved list” when the drugs were prescribed for a medical condition, e.g. an actual ailments. It is obvious to me there has been an entirely different (secret/unwritten) standard used for prescribed psychiatric drugs. Psychiatric drugs do not have to be ‘approved’ to be paid for. This is not an accident or an oversight; it is intentional. It is evidence that criminal behavior is entrenched, and accepted within the Federal child welfare and mental health service systems.
It is all well and good to prosecute corporate entities, and to investigate the failures of government programs. However, without prosecuting the individuals who commit crimes, the necessary lasting changes will not be made. How long are we going to allow criminals to continue to act with impunity, while we wring our hands and hope they ‘fix the system.’ Is it a reasonable expectation that psychiatrists will do anything but continue to vehemently defend the unscientific diagnostic criteria and unethical treatment standards they are using which have necessitated repeated investigations into the mistreatment and medical abuse of foster children? Protecting foster children from being harmed by psychiatric drugs is not the plan. monitoring the continued use of this dangerous paradigm of care is the plan.
The Policy Lab article “Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care”
When my son was prescribed Risperdal I naively believed that doctors do not lie about the nature of psychiatric diagnoses and I had no clue that doctors could prescribe drugs to children that had never been tested and proven to be safe and effective. I was not told of the profound deleterious effects or the risks that I now know are common, and well documented. I was not told that the neuroleptic drugs, were NOT approved for use in children, and I certainly had no clue that Medicaid was being defrauded in order to pay for the drugs which have harmed, but did not help my son! I had no way of knowing that the trust I had in the medical profession, and specifically, the trust I had for psychiatrists was misplaced; and entirely undeserved. In effect, and in fact, every regulatory and ethical safeguard which should have protected my son, and enabled me to make informed decisions about his care did not. It is a burden I bear to this day…
As bad as it is, it is not the fraud and corruption that most anger me. The FDA is not protecting the American people, but it is protecting the drug industry and the unethical standards of care used in psychiatry. Once a drug is approved for any use; the drug can be prescribed to any person of any age for any condition… Many people are still not aware that drugs given to children have never been tested for use on children.
Medicaid Guidelines are to prevent payment for treatments and medical testing that are unnecessary, not proven effective, or for whatever reason, “unapproved;” much like insurance or managed care plans, if it isn’t covered, it isn’t paid for. This system works pretty well: with the glaring exception that is made for psychiatric drugs, which when the use is not approved, are paid for every time, without question… It is plain that this is intentional, and that Medicaid regulations have purposely been ignored altogether. As a result billions of dollars have been defrauded from the American people and have been used to harm vulnerable poor children on Medicaid, and in foster care…
My son is disabled because of the psychiatric drugs prescribed to him as a child without proper consent ever having been given. Most of the drugs that were not “approved” for pediatric use for any reason—and some still aren’t…What useful purpose does the FDA serve, if it is not to protect our children from the harmful negative effects of teratogenic drugs?! Why have we repeatedly investigated the fraud, corruption and the unethical manner that child welfare and mental health services are provided to vulnerable children, without acting on what we have learned? We continue to quantify the enormous harm being done to vulnerable children and adolescents by the psychiatric drugs — and then expect those responsible for the harm to stop practicing medicine unethically; when they they are defending their right to rely on subjective opinions as if being put to a vote turns their professional opinions into empirical evidence which validates these opinions… It does not.
I want to know why. More than that, I want it to stop. I want to know that people who commit crimes and traumatize children will go to prison. I need to know that we as a society will do what is required to protect our children. I want to know that no other child will experience what my son Isaac has.
The repeated investigations and corrective measures have not worked—the evidence is that each successive investigation quantified more harm done to greater numbers of children. I believe it is because corrective measures have been directed at and focused upon ‘the system,’ when it is not ‘the system’ that is the problem. The focus needs to be on individual accountability—-those who lack honesty and integrity who commit crimes harming the children they have a duty to protect, need to be criminally prosecuted every time. Instead, these individuals are protected by the system that is supposed to be protect their victims… This is the biggest problem underlying the whole mess within the child welfare and mental health service systems… Lack of integrity and failure to be accountable. It is not ‘the system’ that is broken and failing, it is the individuals whose negligent and even criminal conduct is accepted. Without a shift in focus, the system will continue to be corrupted by the corrupt individuals within it.
In regards to the drugging of children with psychiatric drugs, it is criminal, plain and simple—it is not based on evidence of efficacy, effectiveness or safety—in fact the evidence overwhelmingly demonstrates the drugs are not safe, or effective for most—The drugs have serious even fatal risks and a small potential for minimum benefit. The drugs can, and do cause dysfunction and disease. It is simply foolish to believe that causing drug-induced diseases, neurological impairments, obesity and heart disease would help a child or adolescent since
Inducing iatrogenic illness is not therapeutic;
It is not in any child’s ‘best interest.’
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.