We can talk of mental health professionals as being on a “higher plane” in knowing the human heart than the rest of us mere mortals, but in truth when it comes to unethical behavior the same factors are in play as with any other profession. Those committing unethical behavior see an opportunity, they have a need that motivates them and ultimately, they justify or can rationalize those behaviors.
Whether a psychiatrist or a plumber, the same sets of factor are in play when poor ethics are involved. On May 23, 2017, a Houston-area psychiatrist was convicted of health care fraud. He was part of a massive, $158 million Medicare fraud scheme. It took only five days for a jury to convict Riaz Mazcuri, M.D. of one count of conspiracy to commit health care fraud and five counts of health care fraud.
The fraud took place over a six-year period, from 2006 until February 2012. Mazcuri was not alone. He had co-conspirators, also mental health professionals who found a way to submit claims to Medicare, through Riverside General Hospital in Houston. The claims were for partial hospitalization program (PHP) services. PHP services are designed for intensive outpatient treatment for severe mental illness. When Mental Health Professionals Commit Fraud.
The Mechanics
The “mechanics” of how the scheme worked was that the mental health professionals saw an opportunity to defraud the system. They bribed and handed out kickbacks to mental health facility group homes and to nursing home employees to send patients to the hospital. Each time the patients would be admitted for treatment, Mazcuri and his cohorts would “render treatment” and get paid. So, they saw an opportunity in the flawed system and motivated by greed, one of the oldest motivators in the book, they were able to admit patients, treat them, readmit the same patients, over and over again. They knew fully well, nothing they could do would change the outcome for example many of these patients suffered from severe Alzheimer’s or dementia. The patients could not possibly benefit from any PHP treatment. It was not only a strategy filled with greed, but it was terribly cruel, devoid of any compassion for the patients or their families.
As there was nothing that the PHP could really do for these poor souls, so Mazcuri almost never saw them. He did not care. Nevertheless, he signed paperwork to say he was treating them.
The only other part of the plan was that Mazcuri had to falsify the medical records to show the patients admitted to the PHPs qualified for treatment and for psychiatric counseling at Riverside. For his part, Mazcuri billed Medicare for nearly $5 million for psychiatric treatment he reportedly provided to Riverside’s PHP patients. He was hardly alone.
Once Mazcuri signed the paperwork for his services Riverside General Hospital could bill Medicare, and they did so for a whopping $55 million. As the case unraveled, 15 others were caught up from the former president of Riverside General Hospital, who was sentenced to 45 years of jail time down to assistant administrators, group home operators, patient recruiters and other physicians.
Rationalization
What could have been the rationalization for all of those involved along with the hospital and its PHP satellite treatment centers? The rationalization could have taken only one realistic and twisted path: indifference. In the indifferent attitude, they felt the government was nothing more than a giant bank with billions of free money, that the patients and their families had no idea of what was going on (and therefore, couldn’t complain) and that in the long run no one could possibly get hurt.
The rationalization did not account for the fact that they were all being unethical, that the “free money” wasn’t free; it was taxpayer money, that the patients were further disoriented and neglected violating any pretense at the Hippocratic oath, and that they were all committing grand theft.
Everyone involved in this case undoubtedly knew that what they were doing was wrong. The minute that bribes were put on the table and the bribe money was picked up, all pretense of ethics was lost. The hospital itself was complicit, but the hospital is no more or less a place. It is bricks and mortar. The hospital functions because of the people who run it. In this case, though opportunity to commit fraud, basic greed and rationalization were all in place, good ethics were not. When Mental Health Professionals Commit Fraud.
At the end of the day, this was an ethical failure. The fact that many were mental health professionals means little. They fell victim to their own weaknesses as healers and care givers.
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