Fraud by physicians against Medicaid
P. Jesilow, G. Geis and H. Pontell
Program in Social Ecology, University of California, Irvine 92717.
The inauguration of the Medicaid program in the mid 1960s ultimately led to
the appearance of a wide range of new forms of illegal behavior by
physicians. The fact that government authorities, instead of individual
patients, were responsible for payments undoubtedly encouraged the large
number of violations. A review of the background of sanctioned physicians
shows an overrepresentation of psychiatrists and foreign medical graduates
as well as minority-group physicians. Interviews with physicians sanctioned
for Medicaid fraud and abuse indicated that they routinely placed the blame
for their violations on the program, their employees, patients, or others.
In particular, they find program guidelines confusing and irrational and
insist that they intrude on what ought to be independent medical judgments.
The enforcers, for their part, maintain that the convicted physicians are
merely rationalizing self-serving and greedy behavior.
