NCJ Number
86649
Date Published
1981
Length
10 pages
Annotation
Medical overservicing (more services than the patient requires) in Australia is defined, and the problems of countering it are considered.
Abstract
Criminal activity can manifest itself under the following notions of medical overservicing: (1) the physician persuades a patient to accept consultation, diagnostic tests, or surgical procedures for the primary purpose of creating gain for the physician: (2) the physician claims to provide services that have not been provided so as to medical fees from a third-party payor; (3) the physician itemizes procedures in such a way as to maximize the fees; and (4) the physician may treat another physician and his/her family to receive insurance income. The medical profession, through its various professional bodies, has refused to acknowledge the possibility that some doctors act criminally within the health care system. The Federal Government and many health insurance funds also appear to maintain the myth of physician purity even when evidence to the contrary is presented. A clearly articulated, legally rigorous agency relationship defined between cost-bearer (government and health funds) and the doctor decisionmaker would reduce overservicing, but there should be evidence from government, health funds, and the profession that such legal mechanisms will be used without bias. Currently, the law probably provides more protection for the medical criminal than for the victim. The changes required to detect and punish the medical criminal within the present system may involve substantial loss of clinical and personal freedom, but it is time to consider whether a free society can afford to bow to the dictates of a professional oligarchy that has neither the will nor the structure to deal with the criminal behavior of its members.