NCJ Number
101439
Journal
Canadian Journal of Criminology Volume: 28 Issue: 2 Dated: (April 1986) Pages: 129-146
Date Published
1986
Length
18 pages
Annotation
This examination of medical fraud and abuse under Canada's publicly financed health insurance plan considers types of offenses, offender motivations, policing problems, and the deterrent value of specific sentences.
Abstract
Types of medical fraud and abuse include manipulation of the timeframe for services, the falsification of services to obtain a greater fee than for the work actually done, the performance of unneeded medical services, specialists' padding of bills to cover kickbacks to referring doctors, and billing for services never performed and patients never treated. Motivations for such fraud and abuse apparently relate to physicians' perceptions of inadequate reimbursement under the program and hostility toward bureaucratic interference in medical affairs. The policing of medical fraud and abuse is complicated by the need to prove criminal intent in fraud cases, the reluctance of patients to testify against their physicians, and the control of fraud and abuse investigations by physician peer review committees in some Provinces. Publicity about particular fraudulent and abusive practices has deterred physicians over short periods, but billing amounts continue to increase over the long term. Justice and deterrence require that offender physicians be treated the same as nonprofessional offenders. 34 references.