Search Terms: mental AND health AND parity, House or Senate or Joint
Document 12 of 103.
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May
18, 2000, Thursday
SECTION:
PREPARED TESTIMONY
LENGTH:
5601 words
HEADLINE:
PREPARED STATEMENT OF DEAN ROSEN SENIOR VICE PRESIDENT OF POLICY AND GENERAL COUNSEL
HEALTH
INSURANCE ASSOCIATION OF AMERICA
BEFORE THE
SENATE
COMMITTEE ON
HEALTH,
EDUCATION, LABOR AND PENSIONS
SUBJECT -
MENTAL HEALTH PARITY
BODY:
Mr. Chairman and members of the committee. I am Dean Rosen, senior vice president of policy and general counsel for the
Health
Insurance Association of America (HIAA). HIAA is the nation's most prominent trade association representing the private
health
care system. Its 294 members provide
health,
long-term care, dental, disability, and supplemental coverage to more than 123 million Americans. HIAA also is the nation's premier provider of self-study courses on
health
insurance and managed care.
Before joining HIAA, I worked for several years as a congressional staff member, including as
health
counsel for the former chair of this committee, Senator Nancy Landon Kassebaum.
I am honored to have the opportunity to address the committee today on the issue of
mental health parity
in
health
coverage. Federal
Mental Health Parity
Legislation
The
Mental Health Parity
Act of 1996, which prohibits employers from imposing annual or lifetime dollar limits on
mental health
coverage that are more restrictive than those imposed on medical and surgical coverage, is scheduled to sunset in September of next year. Some have criticized the act as not going far enough to equalize
mental
and physical benefits.
Senators Domenici (R-NM) and Wellstone (D-MN).have introduced new legislation, the
Mental Health
Equitable Treatment Act of 1999 (S. 796). which would go significantly further. It would prohibit employer-sponsored
health
plans from imposing limits on the number of covered inpatient days or outpatient visits for
mental health
conditions unless the same limits are imposed on medical and surgical benefits. In addition, no limitations whatsoever would be allowed on "severe biologically-based
mental
illnesses" unless the same limitations are imposed on medical and surgical benefits (roughly half the states that have enacted
parity
legislation have coveredonly serious or "biologically-based"
mental
illnesses/l). Employers with 25 or fewer employees would be exempted from the requirements of the legislation.
The issue of
parity
for
mental health
coverage raises a host of complex issues. Some believe coverage for treatment of
mental
illness should be equal with other areas of coverage. On the other hand, added coverage almost always increases costs. One thing is clear:
Mental
illness takes a tremendous toll on our society. According to the Surgeon General's recent report on
mental health,
one out of every five Americans suffers from some form of
mental
disorder,2 with direct and indirect costs to society totaling nearly $
200 billion a year.3
As we seek ways to ensure that the needs of those with
mental
illness are met, there are a number of difficult public policy issues that must be confronted. One of these is the difficulty that
health
care payers sometimes have in effectively administering
mental health
benefits. Related to this is the cost associated with expanded benefit levels. Increases in the cost of
health
insurance, whatever the source, make coverage less affordable and contribute to the growing number of Americans who lack coverage. In fact, it was in the context of the 1996 legislative debate on
mental health parity
that the Congressional Budget Office estimated that a 1 percent increase in premiums would increase the number of uninsured Americans by 200,000. Since then, a number of private economists have estimated that at least 300.000 Americans lose their
health
coverage each time a mandate increases costs by 1 percent.
Vermont Governor Howard Dean underscored the link between coverage mandates, costs, and the number of people who lack
health
insurance in this year's State of the State address, noting that "state-passed mandates have contributed about 25 percent of this year's increase in insurance premiums. Many of these I have supported. But this year I ask the Legislature not to pass any additional mandates .... We cannot vote on the one hand to expand insurance coverage and increase the cost of liability insurance, and then go out in an election year and point the finger elsewhere for the increase in insurance costs."4
As Governor Dean points out, increases in the cost of insurance matter. Ultimately, increased costs are not borne by
health
insurers - they fall on employees and individual consumers. There is a balance that must be achieved between benefit mandates and the cost of insurance - where that balance is struck will have an impact on how many Americans have
health
coverage, and how many do not.
Treatment Options Raise a Host of Complex Issues
Coverage of
mental health
services presents some unique challenges. As the Surgeon General's report recognizes, "
mental health"
itself is difficult to define - what it means is subject to different interpretations that are value- and culture-based.5 As a result, our current conceptions of
mental
illness incorporate a wide variety of conditions of varying significance.6 While some severe
mental
disorders can be diagnosed as reliably as most medical conditions, for a substantial number of other diagnostic categories there is little research evidence.? That is why it is important to consider not only the level of coverage required by
mental health parity
mandate legislation, but also which conditions are required to be covered. As we will see, the costs associated with "severe biologically-based
mental
illnesses" can be better managed than those associated with many other
mental
disorders or with alcoholism and substance abuse.
Roughly one out of every five children and adolescents suffers from a diagnosable
mental
illness or addiction each year, but only 11 percent experience a significant functional impairment.8 Overall, one in five Americans has a
mental
disorder in any given year.9 (Fifteen percent of adults and 21 percent of children between the ages of nine and 17 receive
mental health
services each year.)10
For most
mental
illnesses there is a range of different treatment approaches that may be used. including various forms of psychosocial therapy and, in many cases, pharmacological treatment.11 Unfortunately, for a variety of reasons, treatments that work well in clinical trials can be much less effective in real-world settings.12 Moreover, there has been little research comparing the relative merits of the different treatments available for the various
mental
disorders, and some studies suggest that the characteristics of the therapist may affect outcomes more than the specific treatment used.13 (This is particularly an issue with children.)14
The challenges presented by misdiagnosis are well illustrated by the recent concern that psychotropic medications such as Ritalin may be over-prescribed for many children.15 It now appears that in many cases treatment was, in fact, inappropriate. This is a clear example of how difficult it can be to diagnose certain
mental
disorders, and to determine both when treatment is appropriate and what treatment is appropriate.
Because different courses of treatment may have significantly different costs, this uncertainty complicates the management of
mental health
costs. For instance, a recent study identified five major treatment categories for schizophrenia.
Considering just pharmacotherapy, costs vary. significantly, with the' cost of newer drugs being roughly 100 times that of older, generic ones. 16 In one study of acute-phase depression, researchers found that 20 to 26 percent of the spending was on treatments that were unlikely to provide meaningful benefits.17 For all treatments, the average incremental cost per depression-free case was $
6,031. But for treatment with selective serotonin reuptake inhibitors (SSRIs) alone, the incremental cost per depression-free case was only $
2,351.18
The Costs of Mandated
Mental Health Parity
Uncertainty regarding the diagnosis of many
mental
disorders and the appropriateness and effectiveness of the various treatment options that are available can make the cost of
mental health
benefits very difficult to manage. There have been many different studies of the cost of mandated
mental health parity.
While the approaches used by these analyses vary, some common conclusions may be drawn from a survey of these studies.
First. while the studies may disagree over the exact level of cost, it is clear that there is a cost associated with
parity.
The level of cost varies dramatically based on the type of
health
coverage a person has. The lowest costs are associated with tightly managed
health
maintenance organization (HMO) coverage. However. the cost impact of mandated
mental health parity
coverage is felt much more acutely by consumers with coverage through
health
plans using point of service (POS) and preferred provider organization (PPO) arrangements, and the highest costs typically are associated with indemnity coverage. For instance, one study estimated that
mental health parity
would raise the average family premium for HMO coverage by only 0.6 percent, but also found that the impact on POS coverage would be 3.4 percent, and that the impact on PPO and indemnity coverage would be 4.8 percent.19
It is also important to note that those studies that have claimed that mandated
parity
has no cost, or results in cost savings, have looked at employer-sponsored plans or other
health
benefit programs that adopted managed care at the same time they incorporated
mental health parity
in their benefits. In those cases, the savings resulting from the adoption of managed care masked the cost of expanded coverage for
mental
illness.20 It is also extremely important to note that current discussions about mandated coverage are not taking place in a vacuum. While proponents of
mental health parity
mandates must rely on the widespread adoption of managed care (in particular, tightly managed HMO coverage) to hold down the cost impact of the mandate, they often ignore the fact that legislation being considered simultaneously would banish the very tools insurers and employers must rely on to effectively manage these costs. (Even more ironic is the fact that some are proponents of both types of legislation.) For instance, the Senate version of the Patients' Bill of Rights legislation would require employers to offer a POS option to all employees. Yet as noted above, the cost of
parity
is significantly higher with POS coverage than with HMO coverage.
Perhaps the one issue in the "patient protection" debate with the greatest potential adverse impact is that of
health
plan liability. The negative cost effects of "defensive medicine" are recognized and well documented. For example, in states with weak or no limits on malpractice liability, spending on treatment of heart attacks alone rose 25 percent faster than in states with meaningfullimits--with no appreciable effect on
health
outcomes.21 Several studies have estimated the costs associated with defensive medicine. One study by the Office of Technology Assessment found that up to 8 percent of diagnostic procedures were undertaken because of liability concerns.22 Another study focusing on Medicare beneficiaries found a 5 to 9 percent reduction in services resulted from reducing provider liability pressures.23 An examination of the combined costs of liability premiums and defensive medicine practices found such costs amounted to 5 percent of total costs for an Indiana hospital.24 Even a limited number of lawsuits over wrongful death or denial of care could lead plan administrators to authorize unnecessary care--despite a lack of objective medical information supporting such care--in order to avoid potential lawsuits? Because of the relative lack of information on the most appropriate and effective treatments for many
mental
disorders, this area is particularly vulnerable to defensive over- treatment.
It is not only the so-called "patient protection" proposals that have the potential to undermine managed care's ability to control costs. The Quality
Health
-Care Coalition Act of 1999 (H.R. 1304), expected to be considered by the House of Representatives later this month would, by waiving antitrust restrictions, allow physicians and other
health
care providers to collude and demand higher reimbursement. It also would reduce or eliminate utilization management crippling the ability of
health
plans to control costs. By increasing the prices paid for
health
care and weakening public and private
health
plans' ability to manage costs, over the long run this legislation alone could increase the cost of private
health
insurance by 10 to 13 percent.26 It almost certainly would magnify considerably the impact of any
mental health parity
mandate.
While much of the work on the cost of
parity
focuses on average cost levels, it is important to consider the impact on specific populations. For instance, managed
mental health
networks are not widely available, or even practical, in many rural areas.27 Further, the cost impact of
mental health parity
legislation clearly will be more significant for small employers. But small employers are significantly less likely to offer
health
benefits than are other firms, and their employees are more likely than other workers to be uninsured.28 Moreover, workers in small firms are less likely to be covered by HMOs? Thus, the costs of
parity
are likely to fall hardest on those who are most vulnerable to the loss of coverage.
Not surprisingly,
parity
laws have been shown to result in increased use of managed care and tighter utilization management of
mental health
care services.30 HMO coverage is a good choice for many consumers. However, both public opinion surveys and market penetration data suggest that most Americans are not willing to embrace HMO coverage as their only option. Consumers are increasingly turning from tightly managed HMOs to PPOs, POS plans, and other delivery system models characterized by increased choice and flexibility. HMO market share has declined from 31 percent in 1996 to 28 percent in 1999, whereas PPO market share has increased from 28 percent to 38 percent and POS market share has increased from 14 percent to 25 percent.31
The Public Sector Has a Difficult Time Managing
Mental Health
Benefits As Well Managing the cost of
mental health
coverage is not a concern unique to the private sector. Public sector programs have found this to be challenging as well. There are a number of significant examples of the difficulties the Medicare and Medicaid programs have had in controlling benefits for
mental health
care. Some cases represent outright fraud. Of course, these instances do not imply that all, or even most, providers of
mental health
services act improperly. But they do illustrate the difficulty payers have in managing these benefits.
One example is the Medicare program's experience with coverage for partial hospitalization services. Congress in 1990 expanded Medicare's partial hospitalization benefit, which provides for intensive psychiatric treatment to be provided on an outpatient basis by allowing community
mental health
centers (CMHCs) to provide partial hospitalization services to Medicare beneficiaries. (Prior to that time, Medicare only reimbursed for partial hospitalization services if they were provided in a hospital outpatient department.) The number of centers has grown rapidly since Congress passed the law. Since then, the
Health
Care Financing Administration (HCFA) and the Inspector General of the Department of
Health
and Human Services (HHS) have identified significant waste, fraud, and abuse in the partial hospitalization benefit administered by CMHCs:32
o Between 1993 and 1996 payments to these centers rose significantly - total payments by 342 percent, per capita payments by 319 percent, with average payment per beneficiary, exceeding $
10,000.
o A review of 18 Florida CMHCs concluded that 17 did not provide necessary core services; 89 percent of beneficiaries were not eligible for services; and 100 percent of the services provided were not covered. Payments were suspended to all 18 centers and 15 centers have since been terminated from the Medicare program.
Numerous other instances of waste and fraud have been documented in the
mental health
area?
One estimate put the overall price tag for
mental health
-related fraud (public and private programs) at $
42 billion a year? The same source concluded that: "Psychiatrists make up 8% of doctors, but 18 % of those
health
care practitioners that have been kicked out of the Medicare system for fraud. Last year, ($
)411 million was paid to the government in fines and penalties for
health
care fraud and, 90 percent of that was paid by psychiatrists or psychiatric institutions.
"
Administration of benefits is not the only challenge public programs face. It is clear that public payers also recognize the importance of balancing cost and coverage is clearly recognized. For instance, new Medicare guidelines have just been announced to more directly recognize the importance of cost when deciding what items and services will be covered by the program.35 In contrast to the long-standing rule that care would qualify for coverage if it was "reasonable and necessary," the new rule requires clinical evidence of effectiveness and "added value" over alternatives that are already covered. This policy change illustrates that public
health
insurance programs are no more immune to cost pressures than are private programs.
Costs of
Mental Health Parity
Mandates Would be Borne by Consumers and Employers
Health
insurers act as financial intermediaries. The costs of the benefits we provide are passed on to our customers in premiums. Ideally.
health
insurers would like to sell as much coverage as possible. However, the benefits provided by insurers are determined by the demands of the markets we serve and the prices that our customers are willing and able to pay.
Employers have made a significant commitment toward addressing the
mental health
needs of their employees. Some level of coverage for inpatient and outpatient
mental health
care is provided to over 90 percent of the employees participating in employer-sponsored
health
plans? The past 10 years have also seen the introduction of many new pharmaceutical treatments for
mental
disorders.37 At the same time these innovative new drugs have become available, private prescription drug coverage, which makes no distinction between
mental
and physical disorders, has grown dramatically? In addition, a growing majority of employer-sponsored plans are addressing workers'
mental health
needs outside of the traditional
health
benefit plan, through innovative approaches such as Employee Assistance Programs (EAPs).39 Many. however, do find it necessary to take some action to limit the cost of
mental health
coverage.
The cost of
health
coverage is not just a parochial concern of employers, but is perhaps the primary
health
policy challenge facing the nation. Roughly 44 million Americans lack any
health
insurance coverage. The primary reason so many are uninsured is the high cost of
health
care and
health
care coverage? In fact, research shows that the decline in employer-sponsored
health
insurance coverage over the period from 1979 to 1995 can be attributed almost entirely to the increase in
health
care spending relative to personal income.41 One out of five uninsured Americans is offered
health
coverage by an employer but declines it - when asked why, twothirds of them cite the cost.42
In May of 1998. the HIAA Board of Directors formally adopted a policy (InsureUSA) for dealing with the problem of the millions of Americans who lack
health
insurance coverage. Since that time. HIAA has aggressively promoted the proposal, because HIAA believes the uninsured are the most significant long-term threat to the American
health
care system. Two central themes of the InsureUSA proposal are a firm commitment to private
health
insurance markets and a recognition of the need to help low-income Americans gain access to coverage.
Because uninsured Americans are not all identical, there is no single solution for them all. InsureUSA recognizes that there is a role for both the public and private sectors and for both employer-sponsored and individually purchased
health
insurance. However, the high cost of coverage is a constantly recurring problem that must be addressed if we are to make meaningful headway in providing
health
care coverage to more Americans.
As the number of Americans unable to afford
health
insurance has risen, the number of specific benefit mandates has also skyrocketed, adding significantly to the cost of coverage. The number of state mandates has increased 25-fold during the last two decades, making
health
insurance disproportionately more expensive for small companies and causing as many as one in four Americans to be uninsured.43 For example, mandates account for 21 percent of
health
insurance claims in Virginia, 11 to 22 percent of claims in Maryland, and 13 percent of claims costs in Massachusetts.44
At least one in five (and perhaps as many as one out of every four) uninsured Americans lacks coverage as a result of the cost of these mandates? As employers try to keep their
health
plans affordable, they must carefully consider which benefits are most valuable to their employees and their families. Survey research indicates that while most Americans support coverage for
mental
disorders, that support decreases when they realize that it will result in higher premiums, and that they generally consider coverage for physical disorders more important than coverage for
mental
disorders.46 In addition, there is greater public support for the coverage of such severe
mental
disorders as schizophrenia than there is for coverage of other conditions.47 These priorities are naturally reflected in the decisions they and their employers make when purchasing
health
insurance. While there is disagreement mound the level of cost associated with
parity,
it is clear that there is a cost and that this increased cost will put
health
insurance out of reach for some Americans. Recently, Dr. William Custer of Georgia State University, performed a study for HIAA that looked at the impact that state
health
insurance laws and regulations have on coverage levels. The one benefit mandate that he included in the study was mandated
mental health
coverage. This study was unique in that it directly measured the impact on the number of people who have
health
insurance coverage. Dr. Custer found that in states that mandate coverage for
mental
illness, the likelihood that a given citizen will be uninsured increases by 6 percent.48 Similarly, estimates of the impact of the number of Americans who would lose
health
insurance coverage as the result of a full federal
parity
requirement range from 800,000 to 3.2 million.49 The highend estimate represents more than three times the number of Americans who lose coverage each year due to all other causes, and even the low-end estimate would double the number of Americans who lose coverage.50
Conclusion
There is a perception that private
health
care plans have unlimited dollars for coverage, and therefore, expansions of benefit plans are an acceptable way to bring more services to insured persons. We must understand that not everyone has the high level of employer contributions that federal employees enjoy, nor do businesses have unlimited dollars for the
health
benefits programs that they voluntarily offer to their employees. Nor do consumers have unlimited dollars for
health
care coverage given other competing demands. Each group, no matter how well intended, that advances one level of benefits may fail to see the effects of its advocacy for extended coverage as it relates to the efforts of other groups. While we can argue over the merits of individual mandates, the fact is the cumulative impact can be devastating, particularly for those Americans who are most vulnerable to cost increases.
And let me add one additional note on the issue of mandated benefits. All too often when a mandated benefit is proposed, the benefit mandated can become far more extensive in scope than originally intended. Take the current discussions in both houses of Congress on the issue of emergency room services. The original intent of many legislative proposals was to guarantee insured persons the right to payment for their emergency care services if their condition, or their perception of their condition, warranted a trip to an emergency facility. Now, however, when we talk about mandates on emergency care, we include payments for post-stabilization services as well as maintenance. All too often legislative proposals dictate not only the benefit required but the terms of the service, how it must be provided, whether it can be exempt from any utilization review or plan oversight, and so on. As the scope of the mandate itself expands, so does its costs.
Mr. Chairman, HIAA's members share the concerns of this committee about the impact that
mental
illnesses have on patients, their families, their employers, and our society. However, we must also recognize that extending full
parity
in this area will drive up the costs of coverage, and increase the number of uninsured Americans. Instead. we believe that we must work together to expand
health
coverage to as many consumers as possible.
Again, thank you for the opportunity to testify today. I am happy to answer any questions you may have.
Thank you.
FOOTNOTES:
1 Merrile Sing et al., The Costs and Effects of
Parity
for
Mental
Health
and Substance Abuse Benefits, U.S. Department of
Health
and Human Services. Public
Health
Service, March 1998, p. 5.
2
Mental Health.
' A Report of the Surgeon General. U.S. Department of
Health
and Human Services, Substance Abuse and
Mental
Heath Services Administration.
Center for
Mental Health
Services, National Institutes of
Health,
National Institute of
Mental Health,
1999, p. 46.
3
Mental Health:
A Report of the Surgeon General, p. 411, 412.
4 Howard Dean, 2000 State of the State Address, January 4, 2000.
5
Mental Health;
A Report of the Surgeon General, p. 5.
6 For a discussion of the how conditions come to be included in the Diagnostic and Statistical Manual of
Mental
Disorders (D,S.M.) see Joe Sharkey. "It's a Mad, Mad, Mad, Mad World: You're Not Bad, You're Sick. It's in the Book," New York Times. September 28, 1997, Section 4. page 1.
7 Grayson Norquist and Steven E. Hyman. "Advances in Understanding and Treating
Mental
Illness: Implications for Policy,"
Health
Affairs, September/October 1999, p. 35.
8
Mental Health;
A Report of the Surgeon General, p. 124.
9
Mental Health;
A Report of the Surgeon General. p. 20.
10
Mental Health;
A Report of the Surgeon General, p. 408. 409.
11
Mental Health;
A Report of the Surgeon General, p. 65.
12
Mental Health;
A Report of the Surgeon General, p. 72.
13 Issues in
Mental Health
Care Benefits: The Costs of
Mental Health
Parity.
EBRI Issue Brief Number 182, Employee Benefit Research Institute, February 1997, p. 13. John Morgan, "Why Freud Isn't Dead," Scientific American. December 1996.
14
Mental Health:
A Report of the Surgeon General, p. 140.
15 Julie Magno Zito et al., "Trends in the Prescribing of Psychotropic Medications to Preschoolers," Journal of the American Medical Association, February 23, 2000, p. 1025. "Psychiatric drugs soaring among toddlers." USA Today. February 22.2000. Al Neuharth, "Drugging unruly kids lazy parents' cop-out," USA Today, December 17, 1999.
16 Anthony F. Lehman, "Quality of Care in
Mental Health:
The Case of Schizophrenia,"
Health
Affairs, September/October 1999, p. 55.
17 Richard G. Frank et al.. "The Value of
Mental Health
Care at the System Level: The Case of Treating Depression,"
Health
Affairs, September/October 1999, p. 85.
18 "The Value of
Mental Health
Care at the System Level: The Case of Treating Depression," p. 82, 85.
19 The Costs and Effects of
Parity
for
Mental Health
and Substance Abuse. p. 32.
20 For a graphic illustration of this offset effect, see
Parity
in Financing
Mental Health
Services. Managed Care Effects on Cost, Access, and Quality, U.S. Department of
Health
and Human Services, National Institutes of
Health,
National Institute of
Mental Health,
May 1998, p. 18.
21 Kessler. D.P. and M. McClellan, "Do Doctors Practice Defensive Medicine?" The Quarterly Journal of Economics, Feb. 1996.
22 U.S. Office of Technology Assessment, Defensive Medicine and Medical Malpractice, July 1994
23 "Do Doctors Practice Defensive Medicine?"
24 Macintosh and Murray, "The High Cost of Medical Liability,." Hudson Institute Briefing Papers, Hudson Institute, April 1994.
25 Gresenz, et al., A Flood of Litigation? RAND. July 1999.
26 Charles River Associates Inc. The National Costs of Physician Antitrust Waivers, HIAA, March 2000.
27 Rural Neglect: Medicare HMOs Ignore Rural Communities, Families USA Publication No. 99-15, Families USA Foundation, September 1999. R.T. Slifkin, et.al.. "Medicaid Managed Care Programs In Rural Areas: A Fifty-State Overview,"
Health
Affairs, November/December 1998.
28 William S. Custer.
Health
Insurance Coverage and the Uninsured,
Health
Insurance Association of America, January 1999.
29 Employer
Health
Benefits. 1999 Annual Survey. Kaiser Family Foundation and
Health
Research and Educational Trust, 1999, p 56.
30 The Costs and Effects of
Parity
for
Mental Health
and Substance Abuse Benefits, p. 15.
31 Employer
Health
Benefits; 1999 Annual Survey.
32 "Fact Sheet. Protecting Medicare's Partial Hospitalization Benefit in Community.
Mental Health
Centers," HCFA, October 5. 1998. In September of 1998 HCFA announced a 10-point program intended to address these problems. This program included: terminating the worst offenders, intensified medical review, and the implementation of a prospective payment system.
33 In February, 1999, Nova Southeastern University agreed to pay the state of Florida $
4.2 million to settle claims of improper billing and the provision of questionable
mental health
care services to Medicare and Medicaid beneficiaries. Shortly before that, Integra, a Pennsylvania-based provider of outpatient
mental health
services, agreed to pay $
3 million to settle charges that it had billed Medicare for unnecessary individual and group therapy provided to nursing home residents. In November of 1998 an Indiana businessman was indicted by a federal grand jury for receiving $
900.000 in kickbacks from two Florida psychiatric hospitals in return for patient referrals. A similar but unrelated indictment was brought against two other businessmen, one from Texas and one from Georgia. In February of this year. Charter Behavioral
Health
agreed to pay $
600.000 to settle Medicare and Medicaid fraud charges involving claims for psychiatric services. Just last month, an Illinois psychiatrist and his office manager were indicted on 15 counts including mail fraud,
health
care fraud, false claims, and conspiracy. They allegedly submitted claims to Medicare. Medicaid. and private
health
plans for services that were never provided and for services provided by unqualified personnel. Also last month, a psychologist in Birmingham, Michigan, was charged with fraudulently billing Blue Cross and Blue Shield of Michigan.
34 "The Hidden Side of Psychiatry: Part I of a 2-Part Series," Alt
Health
Watch. Townsend Letter for Doctors and Patients, January 1997.
35 BNA Daily Report for Executives, May 12, 2000, p. A-13.
36 Paul Fronstin, et al., EBR1 Databook on Employee Benefits, 4th edition, Employee Benefit Research Institute, 1997.
37
Mental Health:
A Report of the Surgeon General, p. 68.
38
Mental Health:
A Report of the Surgeon General, p. 417.
39 Issues in
Mental Health
Care Benefits. The Costs of
Mental Health Parity,
EBRI Issue Brief Number 182, Employee Benefit Research Institute, February 1997, p. 7.
40
Health
Insurance Coverage and the Uninsured: 1990-1998.
41 Richard Kronick and Todd Gilmer, "Explaining the Decline in
Health
Insurance Coverage, 1979-1995/'
Health
Affairs, March/April 1999, p. 30.
42 Kenneth E. Thorpe and Curtis S. Florence. "Why are Workers Uninsured.?" Employer-Sponsored
Health
Insurance in 1997,"
Health
Affairs, March/April 1999. p. 213. Peter J. Cunningham et al., Who Declines Employer-Sponsored
Health
Insurance and is Uninsured?, Center for Studying
Health
System Change. Issue Brief Number 22, October 1999. The Surgeon General's report estimates that 75 percent of the uninsured are in employed families that cannot afford to purchase
health
insurance.
Mental Health
Report of the Surgeon General, p. 419.
43 Gail A. Jensen and Michael A. Morrisey, Mandated Benefit Laws and Employer-Sponsored
Health
Insurance,
Health
Insurance Association of America. January 1999.
44 Jensen and Morrisey, Mandated Benefit Laws and Employer-Sponsored
Health
Insurance.
45 Mandated Benefit Laws and Employer-Sponsored
Health
Insurance.
46
Mental Health.
A Report of the Surgeon General. p. 8.
47
Mental Health.
A Report of the Surgeon General. p. 8.
48 William S. Custer.
Health
Insurance Coverage and the Uninsured.
Health
Insurance Association of America, January, 1999, p. 14.
49 Issues in
Mental Health
Care Benefits.' The Costs of
Mental Health Parity,
p. 11.
50 There were 43.l million uninsured non-elderly Americans in 1997. By 1998 this number had grown to 43.9 million, an increase of 800.000.
Health
Insurance Coverage and the Uninsured, p. 3.
Health
Insurance Coverage and the Uninsured: 1990-1998. p. 1.
END
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