What Are a Social Worker’s Obligations Under the New Jersey Administrative Code When an Insurance Company Demands to Conduct an Audit of Patient Records?

By Eric Marcy |   Apr. 15, 2018

            Health Care Insurance Carriers (“Carrier”) have specific, defined, and limited authority to have access to a licensed Social Worker’s records involving services paid through the Carrier’s Health Insurance Plan. Such access is not unlimited and sometimes an investigator on behalf of the Carrier will show up at the Social Worker’s office and demand to see the complete files identified by the investigator. Typically, such investigations are triggered by either complaints from patients regarding service or billing or a Carrier's suspicions of fraud based upon claims filed. Out of Network Providers, with a large patient base, are potential subjects of audits due to the volume of business and costs incurred by the carrier. It is not unheard of that a Carrier might use the opportunity of an audit to encourage a Provider to become an in-network Provider during the audit process.

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Topics : Health Care, Record keeping, Risk Management, Audits, Professional Licensing, Insurance Company Investigations, Patient Privacy, Patient Records, Social Workers, Patient Confidentiality, Insurance Audits, Insurance Carriers, Insurance Carrier Investigations | 0 Comments Read More


By Eric Marcy |   Jul. 7, 2015



The use of the MMPI-2 is not designed for specific forensic evaluations (i.e. evaluations for legal issues). The MMPI-2 is what is called “broad-band test.” That means it is a tool for general diagnosis. It is based upon test results taken from populations of individuals with already determined psychiatric diagnoses and personality traits to enable psychologists to test a subject and assist in rendering a diagnosis. Without a proper and fair clinical evaluation, the use of MMPI-2 by itself is an unreliable tool for forensic evaluations that present serious legal consequences.

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Topics : Criminal Defense, Scientific Evidence, Criminal Law, Parole, Health Care, Evidence | 0 Comments Read More

The Use And Abuse Of The LSI-R In Parole Evaluations Challenging So-Called "Objective" Testing

By Eric Marcy |   Apr. 15, 2015

The Erroneous Use of and Reliance on the LSI-R

The Level of Service Inventory-Revised “LSI-R” is frequently misused in the context of parole evaluations. Providing an air of scientific reliability, its application in the forensic setting is actually unreliable, subjective, and highly dependent on factors that may be decades old, failing to take into consideration, relevant facts relating to maturity and rehabilitation for which it is not designed to account. While there is authority that supports the efficacy of the LSI-R for determining security risk, classification, programming and custodial placement at the time of initial incarceration, the LSI-R was never designed for and is not appropriate to predict an inmate’s prognosis on parole after years of incarceration.

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Topics : Scientific Evidence, Mental Health, Criminal Law, Psychological Test, discovery, Eric Marcy, Parole, Health Care | 0 Comments Read More

Challenging So-Called "Objective" Psychological Tests: The Use And Abuse Of Psychological Testing In Trials, Sentencing, Parole Consideration, And Custody Disputes

By Eric Marcy |   Apr. 1, 2015

Criminal and civil courts and the New Jersey State Parole Board have accepted the use of psychological testing as an important component of making legal and factual determinations in both the civil and criminal litigation and for considerations as to whether a person is suitable for release on parole. Such testing may add an air of scientific authority resulting in an over reliance on conclusions drawn from the instrument. While psychological testing does add value, the courts recognize and it must be emphasized that the ultimate determinations involving psychological issues reside with the court and/or fact finder. The “objective test” result and related “expert” opinion may be considered, but are not binding on the court and/or fact finder. Given the stakes in establishing defenses in criminal law, sentencing, whether someone may be returned to society in parole determinations, and family law custody disputes, counsel must understand the benefits and limitations of psychological testing in the forensic context.

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Topics : Litigation, Scientific Evidence, Mental Health, Criminal Law, discovery, Parole, Health Care | 0 Comments Read More

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