Health care fraud: physicians as white collar criminals?

White collar crimes are characterized by “deceit, concealment, or violation of trust and are not dependent upon the application or threat of physical force or violence. Such acts are committed by individuals and organizations to obtain personal or business advantage” (Ref. 1, p 3). Health care fraud is a form of white collar crime that may be committed by health care providers, consumers, companies providing medical supplies or services, and health care organizations. There is a trend toward increased participation by organized crime groups in complex health care fraud schemes. There are many different types of illegal and unethical schemes that constitute health care fraud. The common types of fraud committed by physicians include billing for services that were never rendered, providing unnecessary treatments or tests, upcoding (billing for a more expensive diagnosis or procedure), falsifying or exaggerating the severity of the medical illness to justify coding, and accepting kickbacks for referral. Health care fraud has failed to capture the attention of the public or the media. The scandals at Enron, WorldCom, and Adelphi have heightened public awareness of the serious consequences of corporate white collar crime, but there has not been a comparable response to health care fraud prosecutions. For a comprehensive review of corporate white collar crime see Price and Norris. There has been renewed interest by political leaders and prominent government officials in raising public awareness of the enormity of the problem. In addition, investigation of health care fraud is fast becoming one of law enforcement’s major priorities. With the Obama administration’s commitment to health care reform and extending benefits to those currently uninsured, there has been a rigorous effort to curtail the waste due to health care fraud. Attorney General Eric Holder succinctly summarized the salient concerns when he pledged: