Prescription for Profit: How Doctors Defraud Medicaid / Edition 1

by Paul Jesilow, Henry N. Pontell, Gilbert Geis

Overview

In this explosive exposé of our health care system, Paul Jesilow, Henry N. Pontell, and Gilbert Geis uncover the dark side of physician practice. Using interviews with doctors and federal, state, and private officials and extensive investigation of case files, they tell the stories of doctors who profit from abortions on women who aren't pregnant, of needless surgery, overcharging for services, and excessive testing.

How can doctors, recipients of a sacred trust and sworn to the Hippocratic Oath, violate Medicaid so egregiously? The authors trace patterns of abuse to the program's inauguration in the mid 1960s, when government authorities, not individual patients, were entrusted with responsibility for payments. Determining fees and regulating treatment also became the job of government agencies, thus limiting the doctors' traditional role. Physicians continue to disagree with Medicare and Medicaid policies that infringe on their autonomy and judgment.

The medical profession has not accepted the gravity or extent of some members' illegal behavior, and individual doctors continue to blame violations on subordinates and patients. In the meantime, program guidelines have grown more confusing, hamstringing efforts to detect, apprehend, and prosecute Medicaid defrauders. Failure to institute a coherent policy for fraud control in the medical benefit program has allowed self-serving and greedy practitioners to violate the law with impunity.

Prescription for Profit is a shocking revelation of abuse within a once-hallowed profession. It is a book that every doctor, and every patient, needs to read this year.

Product Details

ISBN-13:	9780520076143
Publisher:	University of California Press
Publication date:	07/05/1993
Edition description:	First Edition
Pages:	247
Product dimensions:	6.00(w) x 9.00(h) x (d)

About the Author

Paul Jesilow is Assistant Professor, Henry N. Pontell is Professor, and Gilbert Geis is Professor Emeritus, all in the School of Social Ecology at the University of California, Irvine.

Table of Contents

Preface 
1. Professional Entrepreneurs
2. Medicaid and Medicaid Fraud 
3· The Law in Action: Enforcement in the Medicaid Program 
4· What the Doctors Did 
5· Doctors Tell Their Stories 
6. Conclusions and Speculations 
Notes 
Index

Editorial Reviews

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)

Publishers Weekly - Publisher's Weekly

Since the federal government began determining fees and regulating treatments through Medicaid in the mid-Sixties, some healthcare providers have blatantly taken advantage of the system and fleeced the American public. Jesilow and other colleagues in the School of Social Ecology at the University of California, Irvine, report on doctors, pharmacists, and insurance companies who have been convicted or who have confessed to Medicare crimes. The authors expose the greedy and self-serving behavior of these outlaws, estimated to cost between 10 and 25 percent of the total program cost for state and federal governments. The authors conclude that changes can come about only through a basic overhaul in the medical care delivery system--an issue that is on the front page of newspapers daily. Timely, well written, and carefully documented, this book is sure to keep the reader's interest.-- Patty Miller, New Hampshire Technical Coll. Lib., Laconia

Library Journal