How to Exercise Integrity in Medical Billing: Don't Distort Prices, Don't Free-Ride on Other Physicians.

This paper proposes that billing gamesmanship occurs when physicians free-ride on the billing practices of other physicians. Gamesmanship is non-universalizable and does not exercise a competitive advantage; consequently, it distorts prices and allocates resources inefficiently. This explains why gamesmanship is wrong. This explanation differs from the recent proposal of Heath (2020. Ethical issues in physician billing under fee-for-service plans. J. Med. Philos. 45(1):86-104) that gamesmanship is wrong because of specific features of health care and of health insurance. These features are aggravating factors but do not explain gamesmanship's primary wrong-making feature, which is to cause diffuse harm not traceable to any particular patient or insurer. This conclusion has important consequences for how medical schools and professional organizations encourage integrity in billing. To avoid free-riding, physicians should ask themselves, "could all physicians bill this way?" and if not, "does the patient benefit from the distinctive service I am providing under this code?" If both answers are "no," physicians should refrain from the billing practice in question.

Cheating and sports: history, diagnosis and treatment.

This paper focuses on "cheating" in modern day athletics from youth through professional sports. We briefly summarize a history of cheating in the sports world. We examine the current role cheating plays in sports as well as its causes including, psychodynamic issues, the development of personality disorders and how personality traits become pathological resulting in deception, dishonesty, and underhandedness. We describe management and treatment including psychotherapeutic intervention as well as medication. Finally we discuss a systems approach involving outreach to coaches, families, and related sports organizations (like FIFA, WADA, etc) or the professional leagues which have institutional control and partial influence on the athlete.

Modulatory role of sport factors on amateur and competitive athletes' aggressive and antisocial behaviors.

Aggressiveness and unethical behaviors are an important problem in sports today. Understanding how to properly measure and manage an athlete's aggressive tendency is a crucial lesson to be learned within the rulesets of a sporting environment. This study aims at validating the Italian version of the Competitive Aggressiveness and Anger Scale (CAAS), specifically developed to measure aggressiveness and anger in athletes. The second aim is to investigate how aggressive and antisocial behaviors are modulated by sex, competitive level (i.e., amateur and competitive), sport contact (i.e., contact and no-contact), and sport type (i.e., team and individual). Two hundred and ninety-six athletes (mean age = 22.42 years, SD = 2.86) were asked to fill out a survey about sociodemographic variables, sport specific data, attitudes to moral decisions, past cheating behavior, and aggression. The Italian version of the CAAS presented a good fit of the data, adequate internal consistency and its construct validity was supported via convergent and discriminant validity. Both aggressiveness and anger dimensions of CAAS positively related with acceptance of cheating and gamesmanship, and past cheating behavior, while only the aggressiveness dimension of the CAAS negatively related with prosocial attitude. Competitive male athletes practicing contact sport showed the highest levels of aggressiveness, while competitive athletes practicing team sport showed the highest level of anger. This study represents the first empirical construct validity evidence of CAAS among Italian athletes and provides a deeper understanding of how athletes' aggressive tendencies and antisocial behavior differ across athlete populations.

The effect of achievement goals on moral attitudes in young athletes.

The purpose of the study is to assess the hypothesis that achievement goal orientations will predict sportpersonship attitudes among young athletes, namely that task orientation will predict socially positive attitudes and ego orientation will predict socially negative attitudes. For hundred and eighty two athletes, aged 13 to 16 years completed the Portuguese versions of the Task and Ego Orientation in Sport Questionnaire (TEOSQp) and of the Sports Attitudes Questionnaire (SAQp). Bivariate correlations were used to examine the relationships between TEOSQp and SAQp. Afterwards, relationships between ego orientation and score agreement in cheating and gamesmanship as well as task orientation and score agreement in convention and commitment were examined through EQS (version 5.7). For the estimation of the model, the maximum likelihood method was used. A matrix correlation between the variables (task orientation, ego orientation, cheating, gamesmanship, convention and commitment) showed positive correlations between task orientation and convention (r = 0.29, p < 0.01) and commitment (r = 0. 40, p < 0.01). Ego orientation appeared to be positively correlated with cheating (r = 0.30, p < 0.01) and gamesmanship (r = 0.33, p < 0.01), and negatively with convention (r = -0.16, p < 0.01).The fit of the model was evaluated using the CFI (0.97) and SRMR (0.04). The hypothesized model was confirmed. Task and ego orientations produced a significant effect on prosocial attitudes and on antisocial attitudes, respectively. Task-oriented goals in youth sport programs can represent a relevant framework for promoting prosocial attitudes and consequentely increment the effectiveness of educational interventions. Key pointsSport seems to be an important component of daily physical activity in children and adolescents and its importance is often viewed as positive.Literature suggests that a high task orientation has a positive link with moral variables and a high ego orientation is likely to promote inappropriate behaviours.Task orientation will predict pro-social sport attitudes, and to assess the hypothesis that ego orientation will predict anti-social sport attitudes among young athletes.It is possible to suggest a pattern in which the self-referenced achievement goals can promote the expression of sportspersonship attitudesEnvironmental factors can be more influential than dispositional orientations when it comes to sportspersonship.

Moral Attitudes Predict Cheating and Gamesmanship Behaviors Among Competitive Tennis Players.

Background: The present study tested Lee et al.'s (2008) model of moral attitudes and cheating behavior in sports in an Italian sample of young tennis players and extended it to predict behavior in actual match play. In the first phase of the study we proposed that moral, competence and status values would predict prosocial and antisocial moral attitudes directly, and indirectly through athletes' goal orientations. In the second phase, we hypothesized that moral attitudes would directly predict actual cheating behavior observed during match play. Method: Adolescent competitive tennis players (N = 314, 76.75% males, M age = 14.36 years, SD = 1.50) completed measures of values, goal orientations, and moral attitudes. A sub-sample (n = 90) was observed in 45 competitive tennis matches by trained observers who recorded their cheating and gamesmanship behaviors on a validated checklist. Results: Consistent with hypotheses, athletes' values predicted their moral attitudes through the effects of goal orientations. Anti-social attitudes directly predicted cheating behavior in actual match play providing support for a direct link between moral attitude and actual behavior. Conclusion: The present study findings support key propositions of Lee and colleagues' model, and extended its application to competitive athletes in actual match play.