Perverse Financial Incentives Driving
Atypical Use and Medicaid Costs
Ed Knight, PhD, CPRP
Co-Investigator UCLA
Health Sciences Service Research Center
Atypical Side Effects are the Highest
Medicaid Cost
• 1) Medicaid and medicare costs are out of control.
• 2) The largest costs are safely preventable and will save lives.
• 3) The largest and fastest growing costs are the co-occurring
medical costs connected to mental health services. Much from off
label use which the FDA does NOT approve. Dr Sederer has done an
excellent job of documenting this.
• 4) Off label use of anti psychotic medications for things like sleep
and anxiety causes diabetes, obesity, high blood pressure and high
cholesterol. This is wide spread.
Less Toxic or Non Toxic Products Not
Eliminated
• 5) Most often clinically tested non-toxic
alternatives are not used or even mentioned.
Things like CBT for anxiety, behavior interventions
for anxiety. Acceptance and Commitment
Therapy for anxiety. Nor are less toxic
medications often offered. NOR ARE PATIENTS
TOLD OF THE LIFE THREATENING SIDE EFFECTS of
atypical or other antipsychotics.
Charge to prescribe Charge to Manage
Disease caused
• 6) Many providers, hospitals, managed care
companies then charge disease management
costs in addition to the prescribing. In other
words what diseases they caused by these
off label prescriptions are being billed for and
profits made.
Perverse Financial Incentive
• 7) This payment for managing disease on top
of off label use is a perverse financial
incentive to cause disease to make money
managing it.
Multiple anti psychotics.
• 8) Many people are on multiple antipsychotics. Each
additional one added does not increase any beneficial
effects but does increase obesity, diabetes, high
cholesterol. This also results in billing and profits to
manage the diseases caused this way. This is a perverse
financial incentive to cause disease also.
• There is no profit in taking people off one drug before
putting on another.
• As a matter of fact good care costs money.
• What are we paying for? Not who is profiting!!!
• What are likely savings. VA high ranking Doctors tell me
they save 30% per patient by controlling atypical uses.
Stop companies from making money
by causing disease
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• 9) STOP THIS NOW!!! Make any medical
business responsible for the costs of disease
management for the diseases they cause. STOP
THE MEDICAID RIP OFF OF DOUBLE COLLECTING
FOR DISEASES THEY CAUSE.
• Make Sure these incentives are NOT in your rfp.
• All companies or their partners make money this
way.
• I WILL CONSULT ON THESE ISSUES IF YOU LIKE
What to do
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Ethical Medicaid Medicare Cost
Savings will Save Lives TOO.
Please call your Senator or Representative
Capitol Switchboard
202-224-3121
Ask for your Senator or Representative by name
Find their emails at
www.congress.org
enter your zip code
Web Stuff
• See blogs Perverse Financial Incentives Driving
Medicaid Costs and Disease
• lets-fix-perverse-financial-incentives.html
• Contact Ed Knight for further information
mailto:shamskayum@gmail.com