Unqualified Practitioners
As touched upon earlier, one of the scams involved diagnosing patients with illnesses that did not exist. Phoenix Alcohol and Drug, a patient brokering operation, catered to these hospitals by supplying a constant flow of patients. They operated throughout southern Ontario and sent hundreds of Ontario residents to U.S. psychiatric facilities, where they were treated for the fictional “codependency” malady. Thus, OHIP (and Alberta Health which was also a victim of this device) and other health insurance providers would not pay for its treatment. In order to collect, the psychiatrists had to submit bills that reflected OHIP’s criteria, but that did not reflect the actual “diagnoses” and “treatment” the patient was given. One Texas psychologist, John M. Cull, gave codependency seminars throughout Ontario and also worked in Alberta to recruit patients. One of his colleagues commented in a meeting that: “I have a concern that we are treating codependency while billing for payment under major depression with little to validate this diagnosis. ...Is the Canadian government paying for major depression or codependency?” Cull received $1,050 per OHIP patient upon admission and another $280 per patient day. Documents obtained from the Texas Medicaid Fraud Investigation Unit revealed that his privilege to practice had already been seriously challenged. According to these documents, “When Shelia Lee, Quality Assurance Director inquired of Rufus Hoefer, Hospital Administrator, in September of 1990 if Cull should be credentialed, he replied: ’No need to do that; this is a business relationship. He is not going to be providing any clinical care.’ He couldn’t because of Bd. [board] restrictions.”
The $400 Million Swindle continued...
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