I have been intrigued by the implications of this movie since I saw the first trailer some time ago.  The new Pixar film “Inside Out” reminds me of the many conversations that I have had with clients over the past 30+ years.  So many clients talk about “that voice in my head” or “the committee” and even one client had named her internal critic “Beulah”. Riley’s internal struggles are so very aptly explored in this film.  I hope you go to see the film and comment on my blog about your experiences with clients or your own internal struggles.  What has been your experience with internal struggles?

http://www.npr.org/sections/monkeysee/2015/06/19/414702149/why-the-key-character-in-inside-out-is-the-one-that-isnt-there

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By Catherine L. Waltz, PhD, LCSW
June 16, 2014 revised February 9th, 2015

I have noticed a number of disciplinary cases involving some form of fraud in the minutes of the past quarter’s Board meetings.  These cases are another example of intentional deception to the detriment of some “other”.  The cases I reviewed were frauds committed by Registered Interns.  Examples included falsifying therapy notes and billing for clients who were not seen, falsely claiming to have an academic degree as part of the application to become a Registered Intern, submitting billing for more time than was actually spent with clients, and requesting that a client provide urine (in exchange for privileges) for an employer mandated screening after probable impairment was noticed by the supervisor.

The examples reported above may seem straight forward and easily identifiable as fraudulent acts.  But, what about some practices that we may be tempted to do “for the good of our client”?  For example, what is the harm in “finding a diagnosis” or using an Adjustment Reaction diagnosis for one person of a couple in order to bill the couple’s insurance provider for couple’s/marital counseling?  Is doing so a form of fraud?

Woody (2011) stated that fraud involves an intentional deception to the detriment of another. In the question the “deceived other” is the insurer.  Reimbursements from insurance companies require at least a billable diagnosis.  The utilization of Adjustment Disorder diagnoses has frequently been the route taken by some of our peers.  What should we do when there are no true signs of depression or anxiety and none that truly meet criteria for the supposed Adjustment Disorder?  Should we just go ahead and make the diagnosis, provide the relationship services and bill the insurer?  Wouldn’t that be a fraud?

Let’s look from a different angle.  What are the implications for assigning a diagnosis to a client who doesn’t really meet the diagnostic criteria?  First, the diagnosis becomes a permanent piece of personal medical information in the client’s medical record.  Secondly, it is not very likely that all of us understand the long-term implications of a psychiatric diagnosis on a person’s medical history.  One such implication is potential denial of applications for other insurance made by our clients.  Why might the application be denied?  Failing to disclose treatment for any mental health/psychiatric problem could be considered a purposeful omission when really our client was just thinking that some relationship counseling isn’t really mental health treatment.

Finally, wrong diagnoses (one form of medical/mental health error) are very likely to lead to treatment plans that do not match the presenting problem.  When/if an audit of the services is required by the insurer what will they find?  The consequences could include suit for reimbursement of the payments received, termination of the provider/insurer agreement (which the licensed individual should report to his/her licensure Board and malpractice carrier) and, potentially, a complaint to the Board about the fraud.  I don’t think the supposed benefit to our clients who want to use their insurance outweighs those risks, do you?

References

Woody, R. H. (2011).  The financial conundrum for mental health practice.  American Journal of Family Therapy, 39(1), 1-10.

See also:       www.bobwoodyhelpspsychology.com

- Catherine L. Waltz, PhD, is an adjunct professor in the graduate program of the School of Social Work, Barry University.  She is a continuing education provider in the state of Florida providing courses on professional ethics, laws and rules, supervision, mental health error prevention and a specialist in domestic violence.  http://drwaltz.corecommerce.com/Workshops-At-A-Glance-15.html 

The educational commentaries provided by Dr. Waltz do not constitute a legal opinion.  If legal advice is needed, it is recommended that contact be made with an attorney qualified in the jurisdiction in which you practice or is applicable to your case.  We recommend that you use your knowledge of the law and your code of ethics in conjunction with this information (and any other) when deciding upon a course of action.

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Exemptions to Licensure

December 9, 2014

Exemptions to Licensure © Catherine L. Waltz, PhD, LCSW July 17, 2014 – Revised and Shared with Beginning Counselors of Florida on October 31, 2014 Frequently I am asked when providing continuing education on any of our required courses, “How do agencies (or programs) have unlicensed employees (or trainees) providing counseling services?”  There is confusion […]

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What Is Supposed to Happen in an Hour of Supervision?

November 19, 2014

Eye on Florida Laws and Rules What Is Supposed to Happen in an Hour of Supervision? © Catherine L. Waltz, PhD, LCSW November 19, 2014 Registered interns and licensed mental health professionals often want to know just what constitutes supervision.  Questions about supervision are posted online on Facebook and LinkedIn, emailed to me and sometimes […]

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IMPORTANT UPDATE! For: “I want to start a private practice. What do I need to know?”

October 30, 2014

© Catherine L. Waltz, PhD, LCSW October 29, 2014 This post updates the information previously posted on October 19th based on statutes that are in the process of being changed.  Registered Interns should read this commentary thoroughly.  The prior post has been edited and out-dated information deleted. I’m a Registered Intern; can I have a […]

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I want to start a private practice. What do I need to know?

October 21, 2014

© Catherine L. Waltz, PhD, LCSW October 19, 2014, revised October 29, 2014 I’ve been licensed and working for a while but I really want to be in private practice.  What do I need do first?  I’m a Registered Intern; can I have a private practice? These questions and others have been posed to me […]

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New Course in November – Grief and Mourning

September 29, 2014

Grief and Mourning: The Lessons and Gifts (c) Sherrill Valdes, LCSW New Workshop Offered  by New Trainer on: November 21st, 2014 – 8AM to 3:30PM – 6 CEUS No one is immune from loss. Everyone has experienced loss in their lives and most are aware of how it affected their feelings and behaviors as well […]

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Are you up-to-date with the current Florida Laws & Rules?

September 11, 2014

© Catherine L. Waltz, PhD, LCSW September 11, 2014 While preparing to provide the new Renewal Florida Laws & Rules course I found approximately 15 law changes since 2010.  I focus on those changes when providing the course.  But, I believe that I am going to have to change that process.  It may be necessary […]

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8-hour versus 3-hour Florida Laws and Rules Courses

August 11, 2014

August 11, 2014 Are you confused about the different Laws and Rules courses?  3-Hours versus 8-Hours?  Online versus Live? This commentary is intended to help clarify the current expectations associated with the relevant rules. Rule 64B4-3.0035 requires that applicants for licensure must demonstrate knowledge of the laws and rules for licensure by attending an eight […]

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What teaching means to me despite trials and tribulations. . .

June 23, 2014

I love teaching. I love the sharing of knowledge and challenges between the students and me. One of my strongest values which underlies all that I do is to promote a positive image for the profession and help new social workers develop professionally. Teaching social work courses is my newest way of doing that. Classroom […]

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