Ethical Issues in Physician Billing Under Fee-For-Service Plans.

Medical ethics has become an important and recognized component of physician training. There is one area, however, in which medical students receive little guidance. There is practically no discussion of the financial aspects of medical practice. My objective in this paper is to initiate a discussion about the moral dimension of physician billing practices. I argue that physicians should expand their conception of professional responsibility in order to recognize that their moral obligations toward patients include a commitment to honest and forthright billing practices. I argue that physicians should aspire to a standard of clinical accuracy-not legal adequacy-in describing their activities. More generally, physicians should strive to promote an integrity-based professional culture, first and foremost by stigmatizing rather than celebrating creative billing practices, as well as condemning the misguided sense of solidarity that currently makes it taboo for physicians to criticize each other on this score.

[Conflicts of interest and the ethics of developing fee-charging questionnaires].

　There are some fee-charged questionnaires in the social medicine field. If a questionnaire is fee-charged, the researcher developing it may have a financial incentive, and the existence of a conflict of interest should be considered. Therefore, when a manuscript reporting a fee-charged questionnaire is submitted, future fee-charging and the institution managing the questionnaire should be described as potential conflicts of interest. They should also be so described in forms for ethical review and informed consent.

The making of a moral economy: women's views of monetary transactions in an 'egg sharing for research' scheme.

There are growing debates about the appropriateness of offering money in exchange for the provision of bodily materials for clinical treatment and research. The bioethics literature and many practice guidelines have generally been opposed to such entanglement, depicting the use of money as contaminating, creating undue inducement, exploitation and commodification of the human body. However, two elements have been missing from these debates: (i) the perspectives of those people providing bodily materials when money is offered; and (ii) systematic empirical engagement with the notion of 'money' itself. This article seeks to fill those gaps in knowledge by providing detailed insights from a project investigating the views and experiences of women who volunteered to provide eggs for research in exchange for reduced fees for fertility treatment. Analysis of 29 semi-structured interviews reveals multiple ways in which volunteers reason through the involvement of 'money' in this domain and shows how their accounts diverge from pessimistic understandings of the role of monies in everyday life. When volunteers speak in detail about the monetary aspects of their participation they draw major, recurring, distinctions in five overlapping areas: their depiction of the monetized world of fertility treatment; their views of the different forms that money can take; a distancing of their actions from their understandings of how markets and commodities work; their location of the transactions within a particular clinic, and the ongoing importance of their eggs, post-transaction. This article: (i) responds to calls for concrete case studies to assist understandings of the inter-relationships of money and specific aspects of social life; (ii) adds to the sociology of money literature by providing empirical insights into how notions of money are deployed; (iii) presents much-needed perspectives from providers of bodily materials; and (iv) contributes to ongoing conversations between bioethics and sociology.

Survey on Ethical Conduct Thresholds in Cardiologal Medical Practice in Argentina.

The purpose of this study was to analyze the attitude of a group of cardiologists on the ethical conducts they would accept or adopt when encountered with different hypothetical situations of medical practice. Between August and September of 2011, 700 Argentine cardiologists were surveyed in situations which posed ethical dilemmas in the patient-physician relationship, among colleagues or involving financial agreements with employers or the pharmaceutical industry. Ethical conflicts were evidenced in a series of inappropriate conducts such as differential fees, trips and meals sponsored by laboratories, splitting fees, overbilling, self-referral, charging for patient referral, financial compensation for ordering medical procedures, and various situations derived from the relationship with employers. In general, financial compensation from the pharmaceutical industry was more accepted than the conflictive situations which directly involved patients, colleagues or employers. The rejection of these conducts, the physicians' deontological education and the improvement of financial and organizational conditions in medical practice will help to encourage better medical professionalism and avoid unseemly behaviors.

Should we perform kidney transplants on foreign nationals?

In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians' duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them.

The ethics and regulation of overcharging: issues in the commerciality of the health practitioner-patient relationship.

Overcharging by health practitioners is a difficult issue with few guidelines available for practitioners or patients. For the most part it has not been the subject of disciplinary censure and has been dealt with by conciliation processes. However, during 2013 the Singapore High Court twice addressed the commerciality of the health-practitioner-patient relationship, acknowledging that this is a fundamental attribute of the contemporary dynamic between providers and recipients of health services. In Lim Mey Lee Susan v Singapore Medical Council [2013] SGHC 122, it concluded that the obligation to refrain from overcharging is an inherent ethical responsibility of practitioners and affirmed the suspension for three years of a surgeon with Australian training and tertiary connections for what it classified as grossly excessive charging. In Pang Ah San v Singapore Medical Council [2013] SGHC 266, it observed that medical practitioners have a legitimate right to appropriate levels of remuneration but that the right balance has to be struck between professional virtues and business considerations. The Singapore High Court's decisions raise the question of whether professional associations and practitioner regulators have a responsibility to provide guidelines and, potentially, processes by which practical assistance can be provided to medical and other health care practitioners so that they can avoid unacceptable charging practices.

Business dealings with a patient: money never sleeps.

Mr M.O. Gul returned for his postoperative visit today after you successfully repaired a leaking abdominal aortic aneurysm. Mr Gul owns most of the cable networks in the state, making him a billionaire. He realizes that he met the bearded reaper and walked away because of your skills. He is pioneering a new technology that will make current Wi-Fi obsolete. Unexpectedly, he offers you the opportunity to invest with the expectation of huge returns. M.O. personally guarantees you will not lose money. What should you do? A Invest. No questions asked. B Do not invest. It is unprofessional. C Do not invest without consulting with your attorney. D Do not invest. You have already been paid for services rendered. E Invest provided you forego future medical relationships with M.O. as the attending physician.

Shining the light on physician-pharmaceutical and medical device industry financial relationships.

Long subject to legal scrutiny under the federal Anti-Kickback Statute, financial ties between physicians and drug manufacturers have recently come under additional pressure as a result of recently enacted state and federal disclosure laws and state gift restrictions, the latest coming in connection with the Federal Health Reform Law. These "sunshine" laws have been motivated by the concern that gifts and payments by manufacturers to physicians may lead to conflicts of interest and improperly influence physicians in their drug- or device-prescribing decisions. As a backdrop to these new laws, it is helpful to review prior guidance regarding manufacturer-physician financial relationships, both from the federal government and the industry itself. These laws do not prohibit physician involvement with industry in research and education, but they impose various new compliance requirements on these relationships, and also in many cases, require public disclosure of arrangements that previously were treated as confidential. It is still too early to tell if these laws will stifle innovation, but they do require a heightened degree of diligence to avoid, at a minimum, adverse publicity and embarrassment and, at worst, criminal and civil liability.

Kidneys for sale: who disapproves, and why?

The shortage of transplant kidneys has spurred debate about legalizing monetary payments to donors to increase the number of available kidneys. However, buying and selling organs faces widespread disapproval. We survey a representative sample of Americans to assess disapproval for several forms of kidney market, and to understand why individuals disapprove by identifying factors that predict disapproval, including disapproval of markets for other body parts, dislike of increased scope for markets and distrust of markets generally. Our results suggest that while the public is potentially receptive to compensating kidney donors, among those who oppose it, general disapproval toward certain kinds of transactions is at least as important as concern about specific policy details. Between 51% and 63% of respondents approve of the various potential kidney markets we investigate, and between 42% and 58% want such markets to be legal. A total of 38% of respondents disapprove of at least one market. Respondents who distrust markets generally are not more disapproving of kidney markets; however we find significant correlations between kidney market disapproval and attitudes reflecting disapproval toward certain transactions-including both other body markets and market encroachment into traditionally nonmarket exchanges, such as food preparation.

Charging for investigational drugs under an investigational new drug application. Final rule.

The Food and Drug Administration (FDA) is amending its investigational new drug application (IND) regulation concerning charging patients for investigational new drugs. This final rule revises the charging regulation to clarify the circumstances in which charging for an investigational drug in a clinical trial is appropriate, to set forth criteria for charging for an investigational drug for the different types of expanded access for treatment use described in the agency's final rule on expanded access for treatment use of investigational drugs published elsewhere in this issue of the Federal Register, and to clarify what costs can be recovered for an investigational drug. This final rule will permit charging for a broader range of uses than was explicitly permitted previously.

Caveat Emptor: Predatory Publishers, Rogue Journals, and the Potential Corruption of Addiction Science.

The name predatory publisher has been applied by academic librarian Jeffrey Beall to describe an open-access, scholarly publishing business model in which publication fees are charged to authors without providing the editorial judgment, peer-review process, and publishing services associated with more established journals. In the addiction field, as many as 20 journal titles now operate according to this model, and most of their editors are either nonexistent or impossible to contact. Although predatory publishing should not be equated with open access, this article argues that predatory publishers are diluting scientific quality in the addiction field by taking advantage of the open-access movement. Beyond the damage done to the reputations of naive authors and figurehead editorial board members, there is a cascade of effects resulting from the shabby publication process itself. If the addiction field is to be protected from predatory publishers, all sectors need to be involved. Declarations of "buyer beware" and "the emperor has no clothes" are just the first steps in a process of preventing further damage to the integrity of addiction science. As described in this article, concerted action will be required by authors, editors, and professional societies.

Compensated kidney donation: an ethical review of the Iranian model.

Iran has a program of compensated kidney donation from living unrelated (LUR) donors since 1997. The aim of the program was to address the increasing demand for kidney transplantation in a morally sound manner. The program was successful in terms of increasing the number of kidneys available for transplantation. This paper presents a critical review of the program and its clinical status. Denying organ donors legitimate compensation because of the understandable fear of an organ trade is not morally justifiable, and the Iranian model of compensated LUR kidney donation offers substantial benefits that overcome these concerns. Despite its benefits, the program lacks secure measures to prevent the risk of a direct monetary relationship between donors and recipients, and it must be revised in order to be morally justifiable.