Colorado Shooting Suspect Was Getting Psychiatric Care

By Dan Frosch
The New York Times
Originally published July 27, 2012

James E. Holmes, the Colorado man accused of gunning down 12 people at an Aurora movie theater last week, was being treated by a psychiatrist whose research interests include psychotherapy and the neurobiology of schizophrenia, according to court papers filed by Mr. Holmes’s lawyers on Thursday, the first documented glimpse into his mental health condition.

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According to the court papers, Mr. Holmes had sent a package to Dr. Fenton, which was ultimately seized by the police after a search warrant was executed on Monday.

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In September 2004, Dr. Fenton received an admonition from Colorado’s board of medical examiners for prescribing medications — including the allergy medication Claritin, the sleeping pill Ambien, two tranquilizers and the narcotic painkiller Vicodin — for a few colleagues and her husband on several occasions, and failing to keep proper documentation of the prescriptions. The board noted in its admonition letter that Dr. Fenton was no longer writing prescriptions for people who were not her patients.

The entire story is here.

California places psychologist David Van Zak's license on probation

Psychiatric Crimes Database
Originally published July 5, 2012

On January 26, 2012, the California Board of Psychology placed DAVID VAN ZAK, Ph.D.’s license on probation for five years. According to the Board’s Accusation, Van Zak committed, among other things, repeated acts of negligence by accepting financial gifts from a patient, as well as the patient’s invitation to join her and her husband on a Mexican cruise.

The entire story is here.

Putting dignity to work

By Charles Foster
The Lancet
Originally published June 2, 2012

A profoundly brain-damaged teenage girl is brought to hospital. The nurses undress her and leave her, uncovered, on a trolley in front of some lascivious youths who are waiting in the Accident and Emergency Department. She seems to enjoy receiving their attention; they enjoy giving it. Is this wrong? Yes it is. But what language describes the wrongness? Certainly the four principles laid out by Tom Beauchamp and James Childress in their classic Principles of Biomedical Ethics (autonomy, beneficence, non-maleficence, and justice) can't really help, or can't help without straining uncomfortably. Autonomy isn't offended. Insofar as the girl is capable of exercising autonomous thought, she's all for it, and so are the boys. And there's no real harm here, as harm would conventionally be described. One might say that the maxim “Do good” has been violated, but what does “good” mean?

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In answering that question, and in saying what is meant by “good”, it is hard to avoid using words like dignity. And that, for many, is rather embarrassing. Dignity has a bad reputation among some philosophers. It tends to be thought of as feel-good philosophical window-dressing—the name you give to whatever principle gives you the answer you think is right; as a substitute for hard thinking; as impossibly amorphous or (because of its historical association with the notion of the Imago Dei), as incurably theological. Dignity-peddlers, it tends to be thought, are selling metaphysical snake oil.

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Beauchamp and Childress sometimes falter because their principles are second-order principles, derived ultimately from dignity. Sometimes, to get the right ethical answer, you've got to go to the source. Burrow down deep enough into any bioethical conundrum, and you'll eventually hit dignity.

The entire article is here.

Paulucci psychologist suspended, fined $50K by state board

A Minnesota psychologist who charged thousands of dollars to organize a client’s closets, attend a funeral and visit a gravesite — and accepted dozens of expensive gifts from the client, Gina Paulucci of Wayzata — was suspended indefinitely and fined $50,000 for her actions, according to a Minnesota Board of Psychology order made public this week.

by Jane Friedman
Minneapolis Star Tribune

Originally published May 25, 2012

A Roseville psychologist who charged thousands of dollars to organize a client’s closets, attend a funeral and visit a gravesite — and accepted dozens of expensive gifts from the client, Gina Paulucci of Wayzata — was suspended indefinitely and fined $50,000 for her actions, according to a Minnesota Board of Psychology order made public this week.

Kathryne Sanders, 63, acknowledged in an interview that her professional relationship with the client went over the line, but said her career as a psychologist is likely over, so she won’t have to pay the record fine due upon reinstatement.

State law requires psychologists to observe strict boundaries between professional and personal relationships, and Sanders said “there were definitely issues there. But I also think this is something that is extremely common. I just don’t think it’s deserving of the penalty that I received.”

The entire story is here.

Stalking Patients at Hospitals

By Michele Goodwin
The Chronicle of Higher Education - Blogs
Originally posted on May 23, 2012

Next week, Sen. Al Franken, a Minnesota Democrat, will chair a field hearing on the effectiveness of federal laws to protect patients’ access to care and privacy.  The hearing comes on the heels of Minnesota Attorney General Lori Swanson‘s accusing Accretive Health–one of the nation’s largest debt-collection agencies–of excessive and possibly illegal tactics, including strong-arming patients in Minnesota hospitals.  A voluminous six part report can be found here.  However, the issue extends beyond Minnesota as Accretive has contracts with hospital systems throughout the nation.

According to the attorney general’s report, the Illinois-based collection agency hid in hospital waiting rooms and even stalked patients in convalescing rooms to collect payments before and after treatments.  Those desperate tactics are particularly troubling because they occur when patients are seeking emergency medical care.  The cases highlighted by Swanson’s office detail clandestine debt collection schemes that not only misrepresent hospital staff, but may have a deterrent effect on individuals seeking treatment.

The entire story is here.

Dr. Marjorie Cooper, Baylor University – Ethics and Religious Belief

By Bradley Cornelius
Northeast Public Radio - WAMC
Academic Minute

Dr. Cooper

In today’s Academic Minute, Dr. Marjorie Cooper of Baylor University explains research examining why religious belief doesn’t always translate into ethical behavior.

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Overall,  both Nominals and Devouts showed better ethical judgment than Skeptics.  However, the more narcissistic the subjects, the worse their ethical judgment became.  In fact, at higher levels of narcissism, the ethical judgment of Nominals and Devouts was no better than that of Skeptics.

The brief transcript and audio file is here.

The paper in the Journal of Business Ethics is here.

Court of Appeal Says Psychologist Can Be Disciplined For Misconduct as Family Law Special Master

By MetNews Staff Writer
Metropolitan News-Enterprise
Originally Published May 11, 2012

The state Board of Psychology properly disciplined a licensee for unethical conduct while serving as a special master in a contentious family law case, the Third District Court of Appeal ruled yesterday.

The justices affirmed Sacramento Superior Court Judge Patrick Marlette’s denial of Dr. Randy Rand’s petition for writ of mandate. Rand was challenging the board’s order placing him on probation for five years, based on findings of unprofessional conduct, gross negligence, violation of statutes governing the practice of psychology, and dishonesty.

The entire article is here.

Thanks to Ken Pope for this information.

The Third Appellate District decision is here.

Measuring the Prevalence of Questionable Research Practices With Incentives for Truth Telling

*Psychological Science* has scheduled an article for publication in a future issue of the journal: "Measuring the Prevalence of Questionable Research Practices With Incentives for Truth Telling."

The authors are Leslie K. John of Harvard University, George Loewenstein of Carnegie Mellon University, & Drazen Prelec of the Massachusetts Institute of Technology.

Here is the abstract:

Cases of clear scientific misconduct have received significant media attention recently, but less flagrantly questionable research practices may be more prevalent and, ultimately, more damaging to the academic enterprise. Using an anonymous elicitation format supplemented by incentives for honest reporting, we surveyed over 2,000 psychologists about their involvement in questionable research practices. The impact of truth-telling incentives on self-admissions of questionable research practices was positive, and this impact was greater for practices that respondents judged to be less defensible. Combining three different estimation methods, we found that the percentage of respondents who have engaged in questionable practices was surprisingly high. This finding suggests that some questionable practices may constitute the prevailing research norm.

Here's how the article starts:

Although cases of overt scientific misconduct have received significant media attention recently (Altman, 2006; Deer, 2011; Steneck, 2002, 2006), exploitation of the gray area of acceptable practice is certainly much more prevalent, and may be more damaging to the academic enterprise in the long run, than outright fraud.

Questionable research practices (QRPs), such as excluding data points on the basis of post hoc criteria, can spuriously increase the likelihood of finding evidence in support of a hypothesis.

Just how dramatic these effects can be was demonstrated by Simmons, Nelson, and Simonsohn (2011) in a series of experiments and simulations that showed how greatly QRPs increase the likelihood of finding support for a false hypothesis.

QRPs are the steroids of scientific competition, artificially enhancing performance and producing a kind of arms race in which researchers who strictly play by the rules are at a competitive disadvantage.

QRPs, by nature of the very fact that they are often questionable as opposed to blatantly improper, also offer considerable latitude for rationalization and self-deception.

Concerns over QRPs have been mounting (Crocker, 2011; Lacetera & Zirulia, 2011; Marshall, 2000; Sovacool, 2008; Sterba, 2006; Wicherts, 2011), and several studies--many of which have focused on medical research--have assessed their prevalence (Gardner, Lidz, & Hartwig, 2005; Geggie, 2001; Henry et al., 2005; List, Bailey, Euzent, & Martin, 2001; Martinson, Anderson, & de Vries, 2005; Swazey, Anderson, & Louis, 1993).

In the study reported here, we measured the percentage of psychologists who have engaged in QRPs.

As with any unethical or socially stigmatized behavior, self-reported survey data are likely to underrepresent true prevalence.

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The study "surveyed over 2,000 psychologists about their involvement in questionable research practices."

The article reports that the findings "point to the same conclusion: A surprisingly high percentage of psychologists admit to having engaged in QRPs."

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Most of the respondents in our study believed in the integrity of their own research and judged practices they had engaged in to be acceptable.

However, given publication pressures and professional ambitions, the inherent ambiguity of the defensibility of "questionable" research practices, and the well-documented ubiquity of motivated reasoning (Kunda, 1990), researchers may not be in the best position to judge the defensibility of their own behavior.

This could in part explain why the most egregious practices in our survey (e.g., falsifying data) appear to be less common than the relatively less questionable ones (e.g., failing to report all of a study's conditions).

It is easier to generate a post hoc explanation to justify removing nuisance data points than it is to justify outright data falsification, even though both practices produce similar consequences.

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Another excerpt: "Given the findings of our study, it comes as no surprise that many researchers have expressed concerns over failures to replicate published results (Bower & Mayer, 1985; Crabbe, Wahlsten, & Dudek, 1999; Doyen, Klein, Pichon, & Cleeremans, 2012, Enserink, 1999; Galak, LeBoeuf, Nelson, & Simmons, 2012; Ioannidis, 2005a, 2005b; Palmer, 2000; Steele, Bass, & Crook, 1999)."

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More generally, the prevalence of QRPs raises questions about the credibility of research findings and threatens research integrity by producing unrealistically elegant results that may be difficult to match without engaging in such practices oneself.

This can lead to a "race to the bottom," with questionable research begetting even more questionable research.

----------------------
Thanks to Ken Pope for this information.

The abstract and article are here.

Vignette 13: Troubles in the ICU

You are a psychologist in a busy acute care hospital where you receive frequent consultation requests by the trauma service.  A physician requests a psychological evaluation of a 46-year-old man who attempted suicide via over dose of prescription medications along with alcohol. You arrive in the intensive care unit where the patient’s respiratory status is rapidly deteriorating. He is marginally coherent and unable to give any consistent responses.  However, upon his arrival in the emergency department, the medical record quotes the patient as saying, “This wasn’t supposed to have happened.”

The ICU nurse asks you to offer an opinion regarding the patient’s capacity to accept or refuse intubation.

While you are there, a family member arrives with a copy of a notarized advance directive, created within the last year, which specifically outlines the patient’s wishes not to be placed on a ventilator or any artificial life support. The ICU staff asks for your input.

What are the ethical issues involved?

What would you do in this situation?

Would your answer differ if the advanced directive was created 7 years ago or greater?

Would your answer differ if there were no advanced directives?

Military-Funded Brain Science Sparks Controversy

By Charles Choi

InnovationNewsDaily

Originally published March 20, 2012

Brain research and associated advances such as brain-machine interfaces that are funded by the U.S. military and intelligence communities raise profound ethical concerns, caution researchers who cite the potentially lethal applications of such work and other consequences.

Rapid advances in neuroscience made over the last decade have many dual-use applications of both military and civilian interest. Researchers who receive military funding — with the U.S. Department of Defense spending more than $350 million on neuroscience in 2011 — may not fully realize how dangerous their work might be, say scientists in an essay published online today (March 20) in the open-access journal PLoS Biology.

The entire story is here.

Counseling Conflict

By Allie Grasgreen
Inside Higher Ed
Originally published March 26, 2012

Georgia State University’s decision this month to replace its counseling center staff with outsourced employees is worrying those in the field, who say such moves are extremely rare and will likely prove detrimental to the mental health services available to students.

The shift is doubly troubling because a number of former staff members (as well as others in the field) are accusing the university of outsourcing services as a retaliation for their complaints that some university policies involving the counseling center had the potential to hurt students. While the outsourcing was announced shortly after the complaints were made, the university says there was no relationship between the two developments. The director and two associate directors will stay on as full-time employees of Georgia State, spokeswoman Andrea Jones said.

The university says it replaced its nine counseling center clinical positions (three of which were vacant) with contracted employees “in order to increase institutional effectiveness in delivering mental health services to students.”

Because the staff were eliminated through a “reduction in force” process, which is done without regard to an employee’s performance, the change could not have been retaliatory, Jones said. The new model will mimic that of Georgia State’s psychiatry services and health center (both of which commonly use independent contractors).

The entire story is here.

Lying to Patients: No Huge Ethical Failure, Says Bioethicist

By Art Caplan, PhD

Medscape: Ethics

Dr. Art Caplan

Today I would like to talk to you about a pretty thorny subject and one that is fascinating because it is so ethically rich: Should doctors ever lie to their patients?

The trigger for this discussion is a study that just came out that found that doctors do lie. In fact, the study found that 20% of more than 2000 doctors surveyed admitted that they had not told patients the truth when an error had taken place. They found out that more than 10% hadn't discussed financial conflicts of interest, and 15% said they gave a rosier picture about prognosis and risk and benefit with respect to a disease.

There has been a good deal of interest in this survey, and the public and some media reports are saying that this is shocking. We expect our physicians to always be truthful; this survey apparently shows that there is a considerable amount of lying going on, withholding of the truth, and not being forthright. What's wrong? Is there a huge ethical failure going on out there among doctors and medical practitioners?

The answer is no. It is inexcusable and not advisable to lie about an error. You may dodge a bullet on that one by having the patient not find out, but if it really affects their care, if they wind up harmed, if they wind up having to pay more and it comes out later that you didn't tell the truth or that there was an omission of the fact that an error occurred, you are going to get clobbered. I have seen it again and again in courtrooms. It may seem the easiest way out, to avoid telling the truth when an error takes place, but getting it out there and getting it over with early is the best protection in terms of malpractice associated with error. It isn't lying.

The entire story and video is here.

Vignette 11: An Unexpected Inheritance

A psychologist receives a letter from an attorney indicating that he inherited an old car from Frank Palmer.  Upon reflection, the psychologist recalls that he had treated Mr. Palmer a number of years ago.  Looking through his files, the psychologist cannot find his file, so it must have been more than five years ago.

The psychologist phones the attorney and discovers that Mr. Palmer left him a 1993 four-wheel drive Ford Explorer.  He asked the attorney if anyone is contesting the will.  Apparently, no one is.  The executor is Mr. Palmer’s brother, who lives in a different state.

The psychologist obtains the keys and title for the vehicle.  He drives the car to a local dealer who indicated that the Explorer is worth about $3,500.

The psychologist cannot remember many details about the patient.   He recalled that he was an older person with significant depression who eventually became better.  There is nothing unusual that stands out about their therapeutic relationship.

Feeling guilty, the psychologist calls you on the phone to discuss his feelings and any possible ethical concerns.

What are the potential ethical concerns about this scenario, if any?

What suggestions or options would you give the psychologist?

=============================

While a similar experience happened to a psychologist, for further discussion with students, supervisees, or colleagues, the educator or group leader may want to compare and contrast the ethics and options with different details.

Use the same scenario with an antique car worth $50,000 and a family member is contesting the psychologist’s portion of the will.

Would your opinions change about the ethical issues and options related to the situation.  If so, what is different that changes the opinions?

Health Care Issues Intensify U.S. Debate Over Conscience in the Workplace

By Stephanie Simon

Reuters

Originally published February 22, 2012

Can a state require a pharmacy to stock and dispense emergency contraception -- even when the owner considers the drug immoral?

That's the question at the heart of a long-running legal battle in Washington state, expected to be decided Wednesday with a ruling from the U.S. District Court in Seattle.

It's the latest twist in a contentious national debate over the role of conscience in the workplace.

In recent weeks, the debate has been dominated by religious groups fighting to overturn a federal mandate that most health insurance plans provide free birth control. But the battle extends far beyond insurance regulations.

Asserting conscientious objections, nurses in New Jersey have said they would not check the vital signs of patients recovering from abortions. Infertility specialists in California would not perform artificial insemination on a lesbian. An ambulance driver in Illinois declined to transport a patient to an abortion clinic.

In the Washington case, a family-owned pharmacy in Olympia declined to stock emergency contraception, which can prevent pregnancy if taken within 72 hours of unprotected sex. Co-owner Kevin Stormans says he considers the drug equivalent to an abortion, because it can prevent implantation of a fertilized egg. His two pharmacists agree.

Their decision to keep the drug off their shelves came under fire in 2007, when the state Board of Pharmacy enacted a rule requiring pharmacies to stock and dispense all time-sensitive medications in demand in their community. In the case of the Olympia pharmacy, that includes emergency contraception, said Tim Church, a state Department of Health spokesman. The pharmacy's owner and employees filed suit to block the mandate.

All our family wants ... is to serve our customers in keeping with our deepest values," Stormans said in a statement issued by his attorneys.

The state argues that it has a compelling interest in protecting the right of patients to legal medication.

The conscience debate has implications for a vast number of patients. A 2007 New England Journal of Medicine study found that 14% of doctors do not believe they are obligated to tell patients about possible treatments that they personally consider morally objectionable. Nearly 30% of physicians said they had no obligation to refer patients to another provider for treatments they wouldn't offer themselves. A more recent study, published last week in the Journal of Medical Ethics, echoed the finding on referrals.

And abortion and contraception aren't the only medical services at issue. Physicians also may object to following directives from terminally ill patients to remove feeding tubes or ventilators, said Kathryn Tucker, director of legal affairs for Compassion & Choices, an advocacy group that backs physician-assisted suicide.

Entire story is here.

Company withdraws contracts controlling online comments by patients

The move comes after a complaint alleged that Medical Justice's business practices are unethical.

By ALICIA GALLEGOS, amednews staff. Posted Jan. 2, 2012.

Medical Justice Inc. is retiring its "vaccine against libel," a set of contracts providing authority to doctors over online comments posted by patients.

The contracts' demise follows a complaint made to the Federal Trade Commission alleging that Medical Justice is engaging in unethical business practices. A dentist is being sued for using one of the agreements.

The complaint and the lawsuit were filed on Nov. 29, 2011.

A day later, Medical Justice announced it will end its use of the contracts, said neurosurgeon Jeff Segal, MD, CEO and founder of Medical Justice. The company has informed its 3,000 physician and dentist members that the contracts are retired. Medical Justice recommends that doctors use its latest online tool -- the eMerit system -- to combat false posts and protect their reputations. But Dr. Segal said members are "free to do what they want to do," which includes continuing to use the contracts if they see fit. He said the company has not suggested that doctors call their patients to inform them of the contracts' retirement.

The entire story can be read here.

Moral dilemma: Would you kill one person to save five?

Michigan State University News
Released December 1, 2011

C. D. Navarrete, PhD

EAST LANSING, Mich. — Imagine a runaway boxcar heading toward five people who can’t escape its path. Now imagine you had the power to reroute the boxcar onto different tracks with only one person along that route.

Would you do it?

That’s the moral dilemma posed by a team of Michigan State University researchers in a first-of-its-kind study published in the research journal Emotion. Research participants were put in a three dimensional setting and given the power to kill one person (in this case, a realistic digital character) to save five.

The results? About 90 percent of the participants pulled a switch to reroute the boxcar, suggesting people are willing to violate a moral rule if it means minimizing harm.

“What we found is that the rule of ‘Thou shalt not kill’ can be overcome by considerations of the greater good,” said Carlos David Navarrete, lead researcher on the project.

As an evolutionary psychologist, Navarrete explores big-picture topics such as morality – in other words, how do we come to our moral judgments and does our behavior follow suit?

His latest experiment offers a new twist on the “trolley problem,” a moral dilemma that philosophers have contemplated for decades. But this is the first time the dilemma has been posed as a behavioral experiment in a virtual environment, “with the sights, sounds and consequences of our actions thrown into stark relief,” the study says.

The research participants were presented with a 3-D simulated version of the classic dilemma though a head-mounted device. Sensors were attached to their fingertips to monitor emotional arousal.

In the virtual world, each participant was stationed at a railroad switch where two sets of tracks veered off. Up ahead and to their right, five people hiked along the tracks in a steep ravine that prevented escape. On the opposite side, a single person hiked along in the same setting.

As the boxcar approached over the horizon, the participants could either do nothing – letting the coal-filled boxcar go along its route and kill the five hikers – or pull a switch (in this case a joystick) and reroute it to the tracks occupied by the single hiker.

Of the 147 participants, 133 (or 90.5 percent) pulled the switch to divert the boxcar, resulting in the death of the one hiker. Fourteen participants allowed the boxcar to kill the five hikers (11 participants did not pull the switch, while three pulled the switch but then returned it to its original position).

The findings are consistent with past research that was not virtual-based, Navarrete said.

The study also found that participants who did not pull the switch were more emotionally aroused. The reasons for this are unknown, although it may be because people freeze up during highly anxious moments – akin to a solider failing to fire his weapon in battle, Navarrete said.

“I think humans have an aversion to harming others that needs to be overridden by something,” Navarrete said. “By rational thinking we can sometimes override it – by thinking about the people we will save, for example. But for some people, that increase in anxiety may be so overpowering that they don’t make the utilitarian choice, the choice for the greater good.”

A 2-D example of the virtual environment used in this study is available at www.cdnresearch.net/vr

Judgment before principle

Engagement of the frontoparietal control network in condemning harms of omission

By Fiery Cushman, Dylan Murray, Shauna Gordon-McKeon, Sophie Wharton and Joshua D. Greene

Social, Cognitive, and Affective Neuroscience

Correspondence should be addressed to: Fiery_Cushman@brown.edu

Abstract

Ordinary people make moral judgments that are consistent with philosophical and legal principles. Do those judgments derive from the controlled application of principles, or do the principles derive from automatic judgments? As a case study, we explore the tendency to judge harmful actions morally worse than harmful omissions (the ‘omission effect’) using fMRI. Because ordinary people readily and spontaneously articulate this moral distinction it has been suggested that principled reasoning may drive subsequent judgments. If so, people who exhibit the largest omission effect should exhibit the greatest activation in regions associated with controlled cognition. Yet, we observed the opposite relationship: activation in the frontoparietal control network was associated with condemning harmful omissions—that is, with overriding the omission effect. These data suggest that the omission effect arises automatically, without the application of controlled cognition. However, controlled cognition is apparently used to overcome automatic judgment processes in order to condemn harmful omissions.

Moral Psychology and Information Ethics

Moral Psychology and IE

Posted with permission from C.R. Crowell.

Antisocial Personality Traits Predict Utilitarian Responses To Moral Dilemmas

By Daniel M. Bartels and David A. Pizarro

The Mismeaure of Morals:
Anitsocial Personality Traint Predict Utilitarian Responses to Moral Dilemmas
Cognition, Volume 121, Issue 1, October 2011, pages 154-161


Abstract

Researchers have recently argued that utilitarianism is the appropriate framework by which to evaluate moral judgment, and that individuals who endorse non-utilitarian solutions to moral dilemmas (involving active vs. passive harm) are committing an error. We report a study in which participants responded to a battery of personality assessments and a set of dilemmas that pit utilitarian and non-utilitarian options against each other. Participants who indicated greater endorsement of utilitarian solutions had higher scores on measures of Psychopathy, machiavellianism, and life meaninglessness. These results question the widely-used methods by which lay moral judgments are evaluated, as these approaches lead to the counterintuitive conclusion that those individuals who are least prone to moral errors also possess a set of psychological characteristics that many would consider prototypically immoral.

The first two pages of the article can be found here

Bartels, Pizarro

91 charged with Medicare fraud across U.S.

By Jerry Markon

The Washington Post

Published September 7, 2011

The Obama administration escalated its crackdown on health-care fraud Wednesday, announcing charges against 91 people in eight cities who are accused of bilking the Medicare system out of nearly $300 million and victimizing the elderly and disabled people who rely on the federal insurance program.

Among those charged in the coordinated series of arrests was a doctor in Detroit who allegedly billed Medicare for services provided to dead people and claimed that he performed psychotherapy treatments more than 24 hours a day. Other doctors, nurses and health-care company owners were charged in various schemes to get paid for services that were medically unnecessary or never provided, officials said.

“From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank,’’ Lanny A. Breuer, assistant attorney general for the Justice Department’s criminal division, said at a news conference in Washington.

It was unclear whether lawyers had been appointed for the defendants, 70 of whom were charged in indictments unsealed this week. The other 21 were charged in recent weeks. More than 55 defendants had been arrested by Wednesday afternoon, in addition to others who turned themselves in to authorities.

The arrests, announced by Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius, marked the latest step in a campaign against fraud that the administration calls a key part of its health-care reform agenda. The health-care overhaul law, President Obama’s signature domestic initiative, is an issue in the presidential campaign, but few have questioned the need to crack down on fraud.

In May 2009, the administration launched the Health Care Fraud Prevention and Enforcement Action Team to seek out illicit billing practices. That team’s Medicare Fraud Strike Force carried out the raids in cities that also included Houston, Baton Rouge, Dallas and Chicago.

In Miami, 45 defendants — including a doctor and a nurse — are accused of participating in $159 million worth of schemes to submit false Medicare billings for home health care and other services. Holder said the victims included “some of the most vulnerable among us — including seniors suffering from dementia and Alzheimer’s disease.’’

Officials said the crackdown will continue. “The health-care system is part of our nation’s infrastructure, and we must do everything in our power to protect the integrity of Medicare,” said FBI Executive Assistant Director Shawn Henry.

The entire story can be read here.