Medicare/medicaid billing fraud and abuse by psychologists.

Medicare/Medicaid billing fraud and abuse can be prosecuted under a wider array of laws than apply within the private sector. Cases are typically initiated by whistleblowers or through detection of unusual billing patterns. Few psychologists in independent practice have ever been convicted of Medicare/Medicaid billing fraud or abuse, but government antifraud efforts against psychologists appear to be on the rise. These efforts are pursued under the auspices of containing spiraling health care costs, but they can uncover unintentional billing abuse by psychologists, arising from general ignorance of claim-processing procedures, lack of uniformity across insurance programs, constantly changing guidelines, and ambiguous interpretations. Recent investigations in south Texas have especially targeted the use of extenders for psychological and neuropsychological testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective state and awareness of sensory and cognitive effects after closed head injury.

Found that emotional dysphoria was significantly and positively correlated with awareness of sensory and cognitive change in 42 Ss with closed head injury (CHI). Compared with their rehabilitation therapists, Ss tended to underestimate the sensory and cognitive effects of their injury, but agreement between Ss and therapists was highest for those sensory and cognitive functions that Ss could accurately define. S awareness of the sensory and cognitive effects of CHI may be formed from an interaction among at least 4 variables: the assessment measure used, the S's preinjury awareness, motivational influences (e.g., denial), and damage to the frontal lobes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alien hand sign

Usage of the term "alien hand sign" is reviewed in 20 published cases. It refers to apparently purposeful, upper-extremity movements that the patient reports are beyond his/her control. Lesions were found in medial frontal cortex and/or the corpus callosum with presentation being unilateral and transient, unless bilateral cortical and subcortical structures were involved. There was a high co-occurrence of speech hesitation, limb dyspraxia, tactile dysnomia, muscle weakness, and grasp reflex on the alien side. Five behavioral manifestations of alien movement have been described, with grasping movements and intermanual conflict being the most common. Two manifestations, exaggerated ataxic automatisms and drifting movements, likely represent other types of movement disorders. Dysfunction of the supplementary motor area and related structures has been implicated, but the exact causal mechanism remains uncertain.     

Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

American psychological imperialism in the fourth world.

Comments on the article by K. J. Gergen et al (see record 83-32710) which viewed the practice of psychology as primarily a White American enterprise, and considered it a tool of suppression. Gergen et al cited the Maori of New Zealand as an example of how clinical psychology has contributed to the abnormalization of a group who are of non-European ethnicity. The author concurs that the problems associated with American psychology's overuse of White middle-class participants in general (i.e., S. Graham, 1992), and 2nd yr psychology students in particular (i.e., Y. Amir and I. Sharon, 1987), have apparently been exported overseas. Psychology has thrived in America because it has something positive to offer society. If psychology is to thrive in New Zealand, it must accomplish the same goal. The generalization of findings from White participants requires caution, particularly in the cross-cultural application of psychological assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)