Prescription for Profit: How Doctors Defraud Medicaid

In this timely expose of ``tension between . . . medicine as a profession and as a business,'' professors Jesilow, Pontell, and Geis (the latter emeritus) of the University of California's School of Social Ecology contend that since the 1965 establishment of a reimbursement of Medicaid fee-for-service policy, a ``marginal'' group of physicians, in addition to fee-splitting, has been multiplying superfluous visits, needless tests and procedures, and more. (Annual cost of unnecessary surgery in the U.S. is estimated here at $3.92 billion.) Citing case files and extensive interviews with both private medical personnel and government officials involved in enforcing Medicaid and Medicare fees, the authors discuss AMA attitudes, insurance, fraud detection, penalties (suspension, fines) and how guilty doctors tend to rationalize their misconduct. And, anticipating a U.S. national health serivce, the authors appraise those of other countries. (July)