What makes this case of healthcare fraud so egregious isn’t the dollar amount that was stolen, but the lack of checks and balances that permitted repeat offenses by the same provider. It also makes me wonder how many hundreds, maybe thousands of similar cases are discovered every year. In Lancaster, Pennsylvania about a month ago Tammie Sensenig was charged with healthcare fraud.
Tammie Sensenig is a behavioral health consultant. I could not resist, and I had to do some research to determine if my hunches about what a behavioral consultant did were accurate. Sure enough, they often counsel patients on the best therapies to improve their physical and mental health; they teach, consult and treat patients. That’s pretty important stuff, and their patients look to them for advice on their physical and emotional well-being.
When the behaviorist displays unethical behavior, just how effective are they at advising anyone?
If at first you don’t succeed
Tammie Sensenig had been previously charged with Medicaid fraud and in fact, multiple convictions of Medicaid fraud. When she applied for a new job as a behavioral health consultant, she hid the fact that she had prior convictions. Not exactly ethical huh?
Tammie Sensenig started practicing again, obviously giving advice on proper ethical behavior and good mental health. Medicaid paid out nearly $85,000 for her wisdom and compassion before they realized she was one in the same person they had previously convicted.
She could be looking at as much as a ten-year sentence because Tammie Sensensig obviously felt that Medicaid was a huge Golden Goose that was immune to bad ethics and fraud. This time around, Medicaid smelled something a little fishy, and it wasn’t the goose liver pate.
There are two important questions we might consider: What does this say about our system of healthcare that would enable repeat patterns of unethical behavior without consequences? The second question: Can we effectively judge a healthcare delivery system that is rife with bad ethics?
Tammie Sensenig and Repeat Patterns
If our Medicaid system allows for a provider to have multiple convictions without any consequences, it obviously indicates a lack of checks and balances. Just how many Tammie Sensenig’s are practicing in the system now, and what is their impact on the taxpayers? I would doubt we know. It signals the possibility of a widespread ethical breakdown which leads to millions, perhaps tens of millions of dollars in losses on an annual basis. It also suggests a widespread lack of ethical training for providers at all levels. It strikes me that as a condition of Medicaid payments that providers must maintain a current level of ethical training. Would this solve all problems? Sadly, no but it would be an excellent start to weeding out the “Tammie Sensenig Problem.”
How do we judge?
Not to get political, but our new president is trying to eliminate the previous administration’s Affordable Care Act with their own healthcare plan. I can’t say if this is a good thing or bad, but I can’t help but wonder what the financial impact might be on the entire healthcare system if widespread fraud is in play. Virtually every day a new Tammie Sensenig is found – and much larger.
We have written about poor ethics choices not only with physicians, dentists and chiropractors, but in clinics, hospitals, pharmaceutical companies, and even equipment suppliers. What does all of this fraud represent in terms of dollars in system-wide losses? Can we effectively judge the cost-benefit of a major healthcare act and indeed, healthcare system if there is a lack of ethical training? I would argue, “no.”
Let’s also not forget a ripple effect that may be in play. For example, a patient who may be unethically complicit with an unethical provider, such as a patient with Tammie Sensenig or two unethical providers colluding, or a hospital where an unethical “bending of the rules” may be in play. What are the effects of these “attitudes” on the entire healthcare scenario? It is hard to measure, because good ethics are often overlooked in the rush to provide low cost healthcare. Not necessarily good healthcare, but low cost. When a lack of ethics is in play in healthcare, more than money is lost.
WHAT ARE YOUR THOUGHTS?
