A consensus has not yet been reached on definitions of fraud and abuse,
particularly the latter. Further, the terms tend to be linked routinely by
federal agencies, although abuse is generally understood to relate to
inappropriate and fraud to illegal practices. These definitional problems
make it difficult to determine what constitutes fraudulent or abusive
practice in psychiatry. The authors provide hypothetical examples relevant
to psychiatry, noting that in many cases it is still impossible to
determine at what point a practice becomes inappropriate or illegal.
Criteria must be developed by claims review systems, ethics committees, and
PSROs; all those in the mental health field should devote serious attention
to these issues.