Psych Crime Reporter

October 27, 2011

Blue Cross/Blue Shield terminates all Florida psychiatrists

Filed under: Uncategorized — Psych Crime Reporter @ 5:57 pm

In early August, Blue Cross/Blue Shield of Florida sent letters to all of its Florida psychiatrists and other providers under the category of “mental health,” advising them that they would be terminated without cause.

According the Florida Psychiatric Society website (www.floridapsych.org), existing contracts will end in the end of November.

BCBS has said that it is offering coverage through New Directions, which is a managed-care corporation in Kansas, in which Blue Cross/Blue Shield owns the majority of the stock.

This will adversely affect everyone in Florida whose insurance provider is Blue Cross/Blue Shield and who is a patient of a psychiatrist or any other mental-health provider or who be in the future.

This is of special concern to state employees who, after receiving a 3-percent pay cut effective in July, may no longer be able to see their psychiatrist or psychologist if they are in the state’s Blue Cross PPO plan.

If a state employee currently sees a psychiatrist who is in-network and that psychiatrist is out-of-network effective Dec. 1, the state employee will have to meet a $750 out-of-network deductible in December and then again in January. Many state employees who have not met their $750 annual out-of-network deductible will not be able to see their psychiatrist or other mental health professional in December, and then in January will have to pay $750 out of pocket.

After paying the $750 out of pocket, based on surveys of psychiatrists and analyzing the 60-percent reimbursement by Blue Cross/Blue Shield for its “allowable amount,” the estimated average increase per visit by a state employee is over 400 percent for a 45-50-minute office visit. Currently, state employees pay a $25 co-pay for this service.

After November 30, they will typically have to pay their out-of-network physician an average of $200. BCBS has said that it will reimburse state employees $66 (60 percent of their allowable amount of $110). This means that the patient will pay $134 instead of the current $25.

This is a dramatic development that Blue Cross/Blue Shield has tried to keep quiet. It sent cancellation letters to providers but did not inform patients, and as such medical providers had to inform their patients of the bad news. This action is being challenged in court with the help of the American Psychiatric Association, which has advised all its members not to enter into a contract with New Directions because, the APA says, New Directions shares patient information, violates confidentiality and reimburses providers up to 55 percent less than the already low reimbursements by BCBS.

Legally, this cancellation by BCBS seems to clearly violate compliance with the 2008 federal Mental Health Parity Act.

Ethically, it is clearly an act of discrimination against the very large group of individuals and their families who seek services for unavoidable biomedical brain disorders and other conditions. Major depression, treatment resistant depression and bipolar disorders are genetically-based, whole-body medical illnesses.

Thousands of Floridians could lose their ability to function without medication, and the suicide rate could increase dramatically, since the vast majority of suicides are a result of clinical depression. Psychiatrists are among the lowest-paid of all physicians because, unlike other doctors, they do not bill by the procedure and are reimbursed by time.

Psychiatrists save lives every day and are the only specialists uniquely trained and qualified to prescribe certain medications such as anti-depressants, especially to individuals with hard-to-treat and severe depression. There are also other treatments such as ECT, deep brain stimulation and TMS (transcranial magnetic stimulation) performed by psychiatrists that are used when patients do not respond to medication.

In her 2007 book, “Shock,” Kitty Dukakis, wife of former Massachusetts governor and presidential candidate Michael Dukakis, discussed her ECT treatments and how they saved her life.

According to the National Institute of Mental Health and the World Health Organization, mental illnesses are collectively the single greatest disabling disorder among survivors — greater than cancer, cardiovascular disease and diabetes.

Please contact your legislator, members of Congress (concerning the violation of the Federal Parity Act) and AFSCME (the state employees’ union) and ask them to stand with workers and families who will be devastated by this abrupt cancellation of coverage.

Florida legislators are ultimately responsible for the state employee PPO plan. Florida state employees are unknowingly getting the rug pulled out from under them mid-contract with this discriminatory, unethical and unlawful dilution of their health care coverage.

This is a dramatic development that Blue Cross/Blue Shield has tried to keep quiet. It sent cancellation letters to providers but did not inform patients, and as such medical providers had to inform their patients of the bad news. This action is being challenged in court with the help of the American Psychiatric Association, which has advised all its members not to enter into a contract with New Directions because, the APA says, New Directions shares patient information, violates confidentiality and reimburses providers up to 55 percent less than the already low reimbursements by BCBS.

Source: Bill Gallagher, “Mental health coverage change will hurt many,” Tallahassee Democrat, October 21, 2011

New York restricts psychiatrrist Godfrey Mbonu following fraud conviction

Filed under: Uncategorized — Psych Crime Reporter @ 10:01 am

On August 11, 2011, the New York Department of Health Administrative Review Board for Professional Medical Conduct issued a Determination and Order placing the license of Godfrey Mbonu on probation with a permanent restriction to work only in licensed hospital setting, which will remove him from dealing directly with money and billing.

On December 22, 2009, Mbonu pleaded guilty to second-degree grand larceny for defrauding the U.S. Medicaid program and was sentenced April 28, 2010 to one year in prison and restitution of more than $214,000.

An investigation by the New York Medicaid Fraud Control Unit (MFCU) revealed that from 2003 to 2009, Mbonu submitted hundreds of claims to Medicaid for medical services he never provided.

Records obtained by the MFCU showed that Mbonu submitted claims to Medicaid for sessions in his office when he actually was out of the country or when the patient listed was actually hospitalized.

Additionally, it was found that to double reimbursements from Medicaid, he billed Medicaid at the rate for services delivered by a psychiatrist when they were actually provided by a clinical social worker.

Mbonu admitted at his plea hearing to having intended to defraud Medicaid.

Source: Determination and Order No. 11-98, in the Matter of Godfrey U. Mbonu, M.D., State of New York Dept. of Health Administrative Review Board and “NY psychiatrist guilty of $214K Medicaid fraud,” North Country Gazette, December 22, 2009.

New York revokes license of psychiatrist Anastasia Kucharski

Filed under: Uncategorized — Psych Crime Reporter @ 10:01 am

October 26, 2011

 

On September 16, 2011, the New York State Department of Health revoked the license of psychiatrist Anastasia Kucharski on the grounds that she was found guilty of improper professional conduct by the professional disciplinary agency of another state—conduct which, if committed in New York state, would constitute professional misconduct under the law of New York state.

On April 14, 2010, the Massachusetts Board of Registration in Medicine revoked Kucharski’s right to renew her license. Kucharski’s license lapsed on July 28, 2005 and she was notified of this by Board staff on that day. The Board received Kucharski’s renewal application on August 31, 2005.

On or about December 8, 2005, the Board instructed Kucharski to a complete a “Lapsed License Application” if she wished to revive her license to practice medicine. The Board did not received Kucharski’s Lapsed License Application until March 4, 2008.

Kucharski thus practiced on a lapsed license from July 28, 2005 until early March 2008. The Board’s

Order also states that Kucharski practiced medicine without malpractice insurance between over most of a seven-year period between 2000 and 2008 but that on her 2001 license renewal application she indicated that her malpractice insurance carrier was ProMutual.

Lastly, the Board charged Kucharski with fraud for answering “no” to questions regarding criminal arrest, charge, conviction, etc. on her 1992, 1995 and 2008 medical license renewal applications. She was convicted in 1991 for operating a motor vehicle under the influence of alcohol, charged in 1994 with operating a motor vehicle with a revoked registration and operating an uninsured motor vehicle and charged in 2006 and 2007 with operating a motor vehicle on a suspended license, suspended registration and operating an uninsured vehicle (same charges, both instances).

Source: Determination and Order in the Matter of Anastasia Kucharski, M.D., CO-10-04-2681-A, BMPC #11-227, State of New York Department of Health and Final Decision and Order In the Matter of Anastasia Kucharski, M.D., Adjudicatory Case No. 2008-048 (RM-008-824), Massachusetts Board of Registration in Medicine.

Psychiatrist Dennis Pavlinac suspended by state on matter of public welfare

Filed under: Uncategorized — Psych Crime Reporter @ 10:00 am

On September 20, 2011, the Office of Administrative Hearings of the State of California issued an Interim Order of Suspension on psychiatrist Dennis Michael Pavlinac, citing that permitting him to continue to practice medicine will endanger public health, safety and welfare. No specifics have been provided as to underlying reason for the suspension.

Source: Interim Order of Suspension, Whitney v. Pavlinac, Physician and Surgeon Certificate No. G28910, Case No. 10-2011-216768, Before the Office of Administrative Hearings.

County psychologist convicted on felony fraud charge, loses license

Filed under: Uncategorized — Psych Crime Reporter @ 9:51 am
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On September 26, 2011, psychologist Mark Berman surrendered his license to the California Board of Psychology.

According to the Accusation issued by the Board in July 2011, Berman was convicted on October 15, 2010 in Los Angeles Superior Court (case no. MA049821) of knowingly submitting a fraudulent claim to the Medi-Cal program (a felony).

He was sentenced to pay restitution of $152,058.00 and was sentenced to five years probation and ordered to pay a fine.

Berman was an approved Medi-Cal provider of psychological services through the Los Angeles County Department of Mental Health whose patients were referred to him by the court. In 2008, he came under investigation by Department of Mental Health and the State of California Bureau of Medi-Cal Fraud and Elder Abuse, after it was noted that he submitted by far the largest dollar amount of claims for psychological services in all of Los Angeles County for 2004 through 2007.

The investigation, which included patient interviews, revealed that Berman submitting claims for reimbursement to Medi-Cal for treatment that did not take place; that he billed for family therapy (which has a higher reimbursement rate than individual therapy) when he was in fact providing individual therapy and billed for counseling time in excess of the time actually spent with patients, among other violations.

In addition to suspension, he is required to reimburse the Board its costs of investigation and enforcement of $4765.

Source: Stipulated Surrender of License and Order in the Matter of the Accusation Against Mark Berman, Ph.D., Psychologist License No. PSY 9698, Case 1F-2011-213779, Before the Board of Psychology, Department of Consumer Affairs, State of California.

California psychologist billed for patient treatment while HE was hospitalized

Filed under: Uncategorized — Psych Crime Reporter @ 9:50 am
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On June 10, 2011, the California Board of Psychology revoked the license of William Loughman Higgins, Ph.D. The revocation was stayed and Board placed him on probation for five years. This action was taken relative to a Board-issued Accusation which included numerous Causes for Discipline including gross negligence, repeated negligent acts, false or fraudulent claims and dishonesty.

According to the Accusation, Higgins was hospitalized twice for a total of 60 days between May 31, 2007 and August 8, 2007. However, he nonetheless billed patients for services as if they had been delivered during this period.

The Board’s document notes that he billed for 77 sessions purportedly delivered to approximately 31 patients, while he was hospitalized. Higgins sent a letter to a Board investigator falsely stating that a marriage and family therapist handled all of his “sensitive and fragile patients” while he was hospitalized.

Additionally, the document states that Higgins conducted a psychological evaluation of a client who had been referred to him by an attorney. He provided a copy of the finished report to the referring attorney even though he did not have permission from the patient to do so and falsely stated to both the patient and a Board investigator that the evaluation was court-ordered.

Moreover, Higgins incorrectly interpreted the results for tests he administered to the client, his findings were not supported by the test scores, set forth inaccurate information about the patient and failed to take reasonable steps to avoid harm to the patient, including failing to return to her a diary she had given him during their initial meeting.

In addition to probation, Higgins is required to reimburse the Board its costs of investigation and enforcement of $12,000.

Source: First Amended Accusation and Stipulated Settlement and Disciplinary Order in the Matter of the Accusation Against William Loughman Higgins, Ph.D., Psychologist License No. PSY 13206, Case No. 1F-2007-185822, OAH No. 2010120224, Board of Psychology, State of California.

Five mental health counselors among dozes arrested, indicted in massive mental health fraud scheme

According to a federal indictment filed August 25, 2011 in the United States District Court for the Southern District of Florida, the following licensed mental health counselors were indicted for Conspiracy to Commit Health Care Fraud:

Rafael Alalu

Barbara Morales

Debora de Jesus

Gala Myriam Onofre (aka Consuelo Onofre)

Licensed Florida marriage & family therapist Thomas Hamer was also included in the indictment.

Additionally, Alalu, Onofre, Morales and Hamer were indicted for and twelve counts of Health Care Fraud.

These individuals were employees of Biscayne Milieu Health Center, a Miami-area mental health center. The owners, executives and several employees as well as employees of associated agencies are alleged have engaged in actions to submit $50 million in fraudulent claims to the Medicare program, resulting in close to $11 million in reimbursements. The overall scheme involved the recruiting of Medicare beneficiaries from the Southeast to Biscayne Milieu with the promise of providing them housing and services. These beneficiaries, who did not qualify for the services which Biscayne personnel billed Medicaid for, were housed in assisted living facilities and their Medicare numbers were used to create claims for services that were not medically necessary, were not eligible for Medicaid reimbursement, that were never provided.

Source: Indictment, U.S.A. vs Macli, et al, Case tno. 11-20587, United States District Court, Southern District of Florida and Jay Weaver “Medicare fraud case nets dozens of arrests,” Miami Herald, September 7, 2011.

“Nun on the run” mental health counselor sentenced to prison for bilking patients

Filed under: Uncategorized — Psych Crime Reporter @ 9:47 am
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On or about September 13, 2011, Georgia mental health counselor Colleen Higgins was sentenced to four years in prison for bilking clients out of hundreds of thousands of dollars.

From 2007 through 2009, Higgins “borrowed” $277,500 from at least eight clients who loaned her amounts from $2,500 to $90,000.

In July 2009, the Georgia Composite Board of Professional Counselors, Social Workers and Marriage and Family Therapists issued a Notice of Hearing on Higgins for August 18, 2009.

Higgins eventually fled the state, briefly surfacing in a convent in California and then in Iowa, where she was arrested in 2010. The state of Georgia revoked her license in November 2009.

Source: David Ibata, “Fulton counseling admits bilking clients, gets prison,” Atlanta Journal Constitution, September 13, 2011 and Final Decision in the Matter of Colleen M. Higgins, License No. LPC001012, Before the Georgia Composite Board of Professional Counselors, Social Workers and Marriage and Family Therapists.

State suspends counselor Aldo Ivan Rodriquez for sexual misconduct

Filed under: Uncategorized — Psych Crime Reporter @ 9:47 am
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On or about September 7, 2011, the Florida Department of Health (DoH) suspended the license of marriage and family counselor Aldo Ivan Rodriguez for sexual misconduct.

DoH officials said that Rodriguez inappropriately touched two patient while working at the Center for Drug-Free Living between 2008 and 2010.

Rodriguez resigned from the Center in January 2010 and went into private practice but Center officials did not learn of the sexual misconduct until after he’d left.

In a meeting with DoH officials, he admitted to touching the patients. Following a state evaluation in June 2011, he was found to have “violated therapeutic boundaries” and it was recommended that he not see female patients on a one-to-one basis.

Rodriguez is entitled to a hearing before the DoH issues a final decision.

Source: Eloisa Ruano Gonzalez, “State suspends license of Orlando marriage and family therapist, cites ‘sexual misconduct’,” Orlando Sentinel, September 7, 2011.

“Crack pot” mental health counselor suspended

Filed under: Uncategorized — Psych Crime Reporter @ 9:46 am
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On or about August 31, 2011, the Florida Department of Health (DoH) summarily suspended the license of mental health counselor David B. Bollet due to inability to practice safely because of an addiction to crack cocaine and marijuana. News reports state that Bollet was convicted of possession of cocaine and drug paraphernalia in 2011 and 2010, respectively. Bollet is entitled to a hearing before a final DoH decision is issued.

Source: “State suspends license of mental health counselor,” Orlando Sentinel, August 31, 2011.

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