Fraud and abuse of government medical benefit programs by psychiatrists.

Government rosters of physicians suspended from the Medicare and Medicaid programs because of fraud and abuse indicate that psychiatrists form a disproportionately large segment of the total. Of the factors contributing to this situation, the most notable is that because psychiatrists charge for time rather than for services, they are more readily apprehended if they violate the rules. The authors speculate on whether in fact psychiatrists break the law more than physicians in other-specialties or whether the statistics are purely artifactual.

Fraud by physicians against Medicaid.

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.

Medical students' attitudes on physician fraud and abuse in the Medicare and Medicaid programs.

The authors in this paper report the findings of a survey of medical students at the University of California, Irvine, California College of Medicine regarding their views on the Medicare and Medicaid programs and on the problem of fraud and abuse in these government medical benefit programs. The students were asked their views on four issues: (a) the quality of various aspects of Medicare and Medicaid; (b) the seriousness and prevalence of physician fraud and abuse in the programs; (c) the punishment that should be given to violators; and (d) the causes and prevention of fraud and abuse in Medicare and Medicaid. They viewed fraud and abuse as serious but not as being widespread. They believed that physicians who violate program regulations are not likely to be punished by official agencies. They favored moderate penalties for violations. Explanations offered by the students for fraud and abuse focused on physicians' attitudes and motivations as well as on the structure of the Medicare and Medicaid programs.