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.
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.
"A sound, well written, and highly interesting examination of how Medicaid . . . has given far too many physicians an opportunity to 'mop up' fraudulently, for their own financial gain, some of the $61 billion annual cost of the program."—Marshall B. Clinard, author of The Abuse of Corporate Power
"A searching analysis of a problem that is of enormous concern to every nation. It is a lively, insightful treatment of the Medicaid malady, using the best diagnostics available to contemporary criminology."—John Braithwaite, Australian National University