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To reduce wasteful spending, weed out malingering clients

November 20, 2012
by Ben Piercy, NCC, LPC, LMHC, ICADC
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I’m writing to offer a very direct and simple answer to the dilemma of wasteful, duplicative services that you discussed in your September/October 2012 issue editorial. It is driven primarily by a well-established healthcare philosophy of only two factors: prevention of litigation and maximization of billing, regardless of the actual need for care.

This is the problem with our entire healthcare system, but especially behavioral health modalities. The solution is this: Clinicians must be trained to recognize personality disorders, their features and traits, and especially to recognize malingering when it is happening. The over-testing, over-medicating, over-treatment, over-bed stays, over-admissions, etc., can all be eliminated if individuals “using” behavioral health services (especially substance abuse– and addiction-related services, both inpatient and outpatient) are not allowed to have access to the services if they’re proven to have antisocial/narcissistic/learned helpless profiles.

I fully understand that relapse is a part of addiction treatment. But the system as a whole lacks clinical integrity—and everyone in the system knows it, because billing and keeping beds filled is the name of the game.

I would rather authentically assist six people in regaining control of their lives and a reconnection to their community through high-quality treatment and care coordination than be able to “report” that X amount of services was provided to a much larger number of people, or that 30 people “graduated” from a program that held no one accountable. It’s amazing that there’s a treatment system at all for substance abusers, because most of them know it’s a way to avoid being held accountable for payment of child support or other legal charges.

Clinical programs and staff do a deep disservice to these individuals by allowing them to hide in treatment rather than holding them accountable. None of these individuals are really being treated, but programs stay solvent.

I’m intrigued that you wrote an editorial expressing concern about this phenomenon. It’s the dirty little secret of behavioral healthcare. Until personality-disordered malingerers are held accountable and not allowed to compromise the serious nature of the real growth and change others are working hard to effect in their lives, then we are to blame for codependency and malfeasance.

Horn Lake, Mississippi