In this article, the authors provide an overview of the effectiveness of managed health care systems and their impact on mental health counselors. They review ethical and legal dilemmas involving informed consent, confidentiality, client autonomy, competence, treatment plans, and termination that had not existed prior to the introduction of managed health care systems. They outline the relationship between the DSM and insurance reimbursement for delivery of services and examine how MCO regulations regarding certain diagnostic codes prompt intentional misdiagnosis of mental disorders for insurance reimbursement. They provide reasons why insurance reimbursement is denied based on certain DSM diagnostic codes. They examine violations of the American Counseling Association's (ACA; 1995) Code of Ethics and Standards of Practice and the American Mental Health Counselors Association (AMHCA; 2000) "Code of Ethics of the American Mental Health Counselors Association" in relation to intentional misdiagnosis of mental disorders for receipt of insurance reimbursement, as well as legal consequences surrounding this issue. They consider implications for counselors and offer suggestions for professional conduct regarding intentional misdiagnosis.