American Indian and Alaska Native people are being defrauded in a mental health system that has harmed them for centuries; government suspends 100 behavioral providers in crackdown on fraud.

By CCHR International
The Mental Health Industry Watchdog
March 15, 2024

The U.S. Department of Health and Human Services (HHS) has alerted Native American Tribal leaders to suspected fraudulent providers targeting vulnerable American Indian and Alaska Native (AI/AN) people for behavioral treatment. Reports indicate the suspected fraudulent providers entice vulnerable individuals with food, money, and shelter, and offer treatment and safe housing to lure them into facilities, to defraud them.[1] The Citizens Commission on Human Rights International has closely monitored fraudulent mental health schemes for decades, which the American Journal of Managed Care estimates to cost the U.S. $20 million a year.[2]

CCHR says that AI/AN individuals are a prime target for such fraudulent practices due to the unfortunate reality that their understandable and justified responses to historical oppression and genocide have been inaccurately labeled as mental illness. While help should be available to them, the emotional response to an abhorrent situation should not be to define it as a “disease” and lure individuals in to treat it to scam the system.

Initially, suspected fraudulent providers focused on recruiting in reservation communities in Arizona and New Mexico, but more recently there are reports of recruitment efforts throughout Indian Country and direct solicitation to the Indian Health Service, Tribal Health Programs, and Urban Indian Health Programs in an effort to gain referrals.[3]

On May 16, 2023, Arizona Governor Katie Hobbs and Attorney General Kris Mayes joined the Arizona Health Care Cost Containment System (AHCCCS) Administration’s Office of Inspector General (OIG) to announce payment suspensions against registered behavioral health providers of Medicaid services based on credible allegations of fraudulent billing activities. According to an article recently published by the National Council of Indian Urban Health, “This first of many actions to stop these criminal activities was a coordinated effort” by state and federal agencies.[4]

These actions have led to the suspension of more than 100 unique registered behavioral health providers since the announcement, and the search for additional fraudulent providers continues.[5]

Additionally, a Minnesota psychologist was recently sentenced to two years in prison for fraudulently billing Blue Cross Blue Shield of Minnesota and the Shakopee Mdewakanton Sioux Community for over $800,000.[6]

There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of them being labeled with psychiatric disorders, according to an article published in the journal Psychological Services.[7]

This has included psychological-psychiatric eugenics practices, such as sterilization. A study by the U.S. General Accounting Office found that 4 of the 12 Indian Health Service regions sterilized 3,406 American Indian women without their permission as late as 1973 and 1976.[8]

As far back as the late 1800s, in South Dakota for example, an “insane asylum” was created to imprison Native Americans. The Hiawatha Insane Asylum for Indians forcibly committed Native people from across the country, often for reasons that had nothing to do with having a so-called mental disorder.[9]

As many as 100 American Indian residential schools operated in the U.S. from the mid-1800s until the 1960s—a practice based on eugenics which “did all that they could to prevent American Indian children from using their tribal language and observing cultural practices….,” according to Psychiatric News.[10]

Another form of oppression has occurred in foster care. Native Americans are up to four times more likely to have their children taken and placed into foster care than their non-Native counterparts.[11]

David Walker, Ph.D., a Missouri Cherokee descendent, psychologist, and writer states, “In the U.S. foster care system, exhibiting ‘behavioral problems’ and being in need of ‘mental health treatment’ is code for prescribing psychiatric drugs to sedate and ‘manage’ these children. It is easy to become concerned when one learns that foster children and youth in the U.S. take psychiatric drugs at a rate two to three times higher than the general population.”[12]

Further, “Sadly, these statistics are provocative when considering that the 18-24 age range is highest for Native American suicide, which has been consistently the highest rate among all U.S. ethnicities. The Native suicide rate has only climbed over the decades since IHS’s [Indian Health Services] ‘biomedical model’ began emphasizing antidepressants as ‘suicide preventatives.’”[13]

The Food and Drug Administration warns that antidepressants can induce suicide in those up to the age of 24. Additionally, abuse of “psychotherapeutic drugs” by Native young adults aged 18 to 25 spiked 76% between 2018 and 2019.[14] American Indian and Alaska Native teens are more than twice as likely to get mental health treatment than their peers, according to data compiled and released by Health and Human Services in 2021.[15]

Psychotherapeutic drugs, especially antidepressants, are also linked to causing violence. In 2005, in Red Lake, Minnesota, 16-year-old Jeff Weise, on the antidepressant fluoxetine, went to his school on the Red Lake Indian Reservation where he shot dead 5 students, a security guard, and a teacher, and wounded 7 before killing himself.[16] The dosage of the antidepressant was increased a week before the shooting.[17]

“These groups are not only over-represented in being labeled mentally ill, which means excessively drugged, but they are also being defrauded—a triple jeopardy,” said Jan Eastgate, president of CCHR International. Health care is a legal right guaranteed to members of federally recognized Native American tribes. “That care must not include further betrayal by labeling race oppression as a mental ‘illness’ and drugging and institutionalizing those impacted by it,” Eastgate further commented.

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[1] Alex Sampson, “HHS Provides Update on Suspected Behavioral Health Treatment Center Fraud Targeting Native Americans in Arizona,” National Council of Urban Indian Health, 3 Jan. 2024,  https://ncuih.org/2024/01/03/hhs-provides-update-on-suspected-behavioral-health-treatment-center-fraud-targeting-native-americans-in-arizona/

[2] https://www.cchrint.org/2023/02/17/20-billion-in-psychiatric-fraud/, citing Andria Jacobs, “Mental Health Fraud Exacts High Human and Financial Costs,” AJMC, 11 Mar. 2016, https://www.ajmc.com/view/mental-health-fraud-exacts-high-human-and-financial-costs

[3] Op cit., Alex Sampson, National Council of Urban Indian Health, 3 Jan. 2024

[4] Ibid.

[5] Ibid.

[6] Rylee Wilson, “8 recent behavioral health billing fraud cases,” Becker’s Behavioral Health, 21 Nov. 2023, https://www.beckersbehavioralhealth.com/behavioral-health-news/8-recent-behavioral-health-billing-fraud-cases.html

[7] Victoria O’Keefe, “Increasing Culturally Responsive Care and Mental Health Equity With Indigenous Community Mental Health Workers,” Psychol Serv. 2021 Feb; 18(1): 84–92, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824928/

[8] “1976: Government admits unauthorized sterilization of Indian Women,” Native Voice, https://www.nlm.nih.gov/nativevoices/timeline/543.html

[9] Anne Brice, “How the U.S. government created an ‘insane asylum’ to imprison Native Americans,” Berkeley News, 19 Nov. 2020, https://news.berkeley.edu/2020/11/19/using-disability-to-imprison-native-americans

[10] https://www.psychiatry.org/news-room/apa-blogs/how-historical-trauma-impacts-native-americans

[11] “Disproportionate Representation of Native Americans in Foster Care Across United States,” Citizen Potawatomi Nation, 6 Apr. 2021, https://www.potawatomi.org/blog/2021/04/06/disproportionate-representation-of-native-americans-in-foster-care-across-united-states/

[12] David Walker, “A Case Before the U.S. Supreme Court Could Surge the Psychiatric Labelling and Drugging of Native American Foster Youth,” MAD, 9 Apr. 2023, https://www.madinamerica.com/2023/04/supreme-court-drugging-native-youth/

[13] Ibid.

[14] Ibid.

[15] https://www.sandstonecare.com/news/native-teens-mental-health/

[16] “Family: School shooter was on Prozac,” The Herald Times, 26 Mar. 2005, https://www.heraldtimesonline.com/story/news/2005/03/26/family-school-shooter-was-on-prozac/48283597/; https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/202133s000medg.pdf; P.J. Huffstutter, “2nd Teen Is Linked to School Shooting,” Los Angeles Times, 29 Mar. 2005, http://articles.latimes.com/2005/mar/29/nation/na-redlake29; https://www.cchrint.org/school-shooters/

[17] Ibid., The Herald Times, 26 Mar. 2005