In a well-researched, comprehensive article in today’s Huffington Post, Art Levine has brought to the attention of the mainstream media the government’s complicity in the illegal psychiatric drugging of poor children, especially foster children, through Medicaid. The article, Feds Pay for Drug Fraud: 92 Percent of Foster Care, Poor Kids Prescribed Antipsychotics Get Them for Unaccepted Uses is the only mainstream article I know about that has really pressed the federal government over its refusal to enforce Medicaid’s coverage restrictions to “medically accepted indications.” In a nutshell, Medicaid (and Medicare) only allow reimbursement for drugs prescribed for uses approved by the Food and Drug Administration (FDA) or supported by one of three specified drug references called “compendia.” Another way to say it is that off-label coverage is restricted to uses supported by at least one of the compendia.
Discussing a recent Inspector General’s Report, Mr. Levine writes:
“Perhaps even more damning, the report found, 92 percent of all kids on Medicaid receiving antipsychotics don’t have any of the limited ‘medically accepted pediatric conditions’ supposedly justifying their use. These ‘accepted conditions’ include the authority to use antipsychotics even for autistic children as young as 5 for such dubious FDA-approved conditions as ‘irritability.’
“So just how far outside the bounds of sensible prescribing must a doctor be that government approval to provide antipsychotics to a 5-year-old child is somehow considered too limiting? Yet that’s precisely the sort of free-fire-zone prescribing underway now for 92 percent of those kids receiving antipsychotics in foster care and the broader Medicaid program.”
The other side of the coin is the use of neuroleptics (I don’t call them “antipsychotics”) to render nursing home patients incapable of putting up much of a fuss (See Key Unmet Needs Associated with Behavior Problems in Dementia Patients in today’s MIA news). Medicare coverage has the same restriction to medically accepted indications and Mr. Levine notes:
“‘Prevention of [improper] payment [is] beyond our statutory authority,’ HHS’s Center for Medicare and Medicaid Services (CMS) insisted in response to a related 2011 Inspector General report about massive overprescribing in nursing homes.”
In other words, federal officials in charge of Medicaid and Medicare have a formal policy of turning a blind eye to the illegal payment of these prescriptions.
Part of the problem, of course, is that federal Medicaid officials still insist that they don’t have the legal authority to stop paying for worthless and dangerous drug uses; that’s in apparent opposition to a series of federal court rulings and Justice Department fraud lawsuits concluding, as in a $2.3-billion settlement with Pfizer, that the federal government has been defrauded when it’s asked to pay for drug “uses that were not medically accepted indications and therefore not covered by those programs.”
The article goes into some detail about the various fraudulent schemes employed by the drug companies, aided and abetted by prominent psychiatrists, known as “Key Opinion Leaders,” to promote the harmful drugging of children and the mostly sham programs pretending to address the problem. The realization that government officials are unwilling or unable to stand up to the drug companies and doctors is a big reason why the Law Project for Psychiatric Rights (PsychRights®) was founded; to mount a strategic litigation campaign against forced drugging (the drugging of children and the elderly is almost always forced).
The article includes links to PsychRights’ Medicaid Fraud Initiative Against Psychiatric Drugging of Children & Youth and Briefing Paper: The Financial And Societal Costs Of Medicating America’s Foster Children: A Proposed Solution.
The former involves bringing False Claims Act (whistle blower) cases against doctors and pharmacies as a way to curb the practice and the latter suggests the government take the following three steps:
1. Announce that outpatient psychotropic drug prescriptions for use in children and youth that are not for medically accepted indications are not covered under Medicaid, and will no longer be reimbursed, except;
2. Where abrupt withdrawal from drugs that are not for medically accepted indications can cause serious problems, then allow reimbursement for responsible tapering, and;
3. Grant amnesty from False Claims Act liability for all past prescriptions that are not for medically accepted indications.
In the absence of government enforcement of the Medicaid and Medicare coverage restriction to medically accepted indications, PsychRights is looking for people to pursue whistle blower cases to curb these illegal, harmful practices.
PsychRights also urges people to press government officials to enforce Medicaid’s coverage restriction to medically accepted indications.
Again, kudos to Art Levine for having the courage to speak truth to power. I urge everyone to read it and share it, especially with people who are not knowledgeable about this horrific abuse of America’s poor children and youth.
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Videos of Jim Gottstein on the topic of the psychiatric drugging of children & the elderly:
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.