That some therapists engage in sexual misconduct with patients has been unequivocally established. In recent years, however, some patients' allegations of sexual misconduct have been determined to be false. This paper describes four cases in which hospitalized psychiatric patients made false allegations. Such allegations may result from patients' seeking to gain monetarily or in other ways or from a desire for retaliation or revenge against a clinician who they believe has scorned, abandoned, or otherwise mistreated them. In other cases, especially among patients with a history of severe trauma, a patient's psychopathology may be inadvertently stimulated by diagnostic, treatment, or milieu activities. The authors recommend specific institutional responses to allegations of sexual misconduct, such as forming a clinical investigative team, conducting a physical examination, and reporting the charge to outside agencies or investigators when appropriate. Because false claims can have disastrous effects on all involved, clinicians should understand the presentations of such claims and the motivations behind them, and institutions should carefully develop a set of procedures for responding to them.