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Medical Criminals - Physicians and White-Collar Offenses

NCJ Number
Justice Quarterly Volume: 2 Issue: 2 Dated: (June 1985) Pages: 149-164
Date Published
17 pages
After describing various crimes physicians may commit in the context of their professional functions, this article briefly considers issues of physician control and general suggestions for addressing crimes by physicians.
Some doctors have made large profits by prescribing unnecessary amphetamines, valium, opiates, and other controlled substances that often reach the street. This is in violation of the Harrison Act of 1914, which limits physicians' authority to prescribe or dispense opiates. Prior to the U.S. Supreme Court's decision in Roe v. Wade, abortion was illegal in the United States, but prior to that decision (1973), a survey of 388 obstetricians found that 10 percent of them referred patients to abortionists, albeit often for ideological and humanitarian reasons rather than profit. Fee-splitting is another widespread medical practice, although it is illegal in many States. This involves a kickback from one doctor, usually a specialist, to the referring doctor. Medicare and medicaid fraud and abuse is a major problem among physicians. The fee-for-service structure of these Federal benefit programs, based on typical medical payment procedures, makes it easy to overcharge, double bill for services, 'pingpong' (send patients to other physicians for additional treatment), 'family gang' (request to see members of a patient's family even though unnecessary), prolong treatment, and conduct additional fraudulent schemes. Criminal sanctions for medicare or medicaid abuse by physicians have been imposed only in the most abusive cases. Civil actions have more often been used, and the Federal Government has authorized the imposition of triple-money penalties for doctors who abuse benefit programs. Prepaid health care systems would likely eliminate overcharging, but this might cause unscrupulous doctors to increase the volume of services without regard to quality. Overall, there is a need for a fair and effective method to monitor and punish physician misconduct that will be conductive to the honest delivery of quality health care. Forty-nine references are listed.

Date Published: January 1, 1985