Characteristics of Physicians Excluded From US Medicare and State Public Insurance Programs for Fraud, Health Crimes, or Unlawful Prescribing of Controlled Substances

Chen, Alice; Blumenthal, Daniel M.; Jena, Anupam B.

doi:10.1001/jamanetworkopen.2018.5805

Cited by 12 publications

(24 citation statements)

References 19 publications

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“…Similar to previous research findings, low-risk specialties (mostly primary care physicians) were generally more likely than high-risk (largely secondary care physicians) to be excluded by the OIG (see Chen et al, 2018;Pande & Maas, 2013;Pontell et al, 1985). Low-risk medical specialties were largely overrepresented while high-risk specialties were generally underrepresented among physicians placed on the list.…”

Section: Risk Of Medical Malpractice Payment By Medical Specialtysupporting

confidence: 80%

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Two Paths, One Destination: A Demographic Portrait of Physicians Sanctioned by the Federal Government

Burton¹,

Sun²,

Jesilow³

et al. 2022

Journal of Health and Human Services Administration

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There is scarce information about the institutional mechanisms creating the demographic portrait of sanctioned doctors published in the U.S. Office of Inspector General's (OIG) List of Excluded Individuals and Entities (LEIE). The current study examines the demographic characteristics of 1,289 physicians who appeared in the LEIE during a five-year period from 2008 to 2013. The results of a multivariate logistic regression found that sex, country of medical school training, and medical specialty were associated with being excluded by the OIG for a quality of care matter. Findings suggest the demographic portrait of doctors in the LEIE reflects the interplay between the doctors' behaviors and the actions of various agencies. A demographic portrait of physician violators,if one considers the mechanisms generating the list, can be useful for public policy recommendations and action.

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Section: Risk Of Medical Malpractice Payment By Medical Specialtysupporting

confidence: 80%

“…Similar to past research studies, female physicians were less likely than male physicians to be excluded by the OIG (see Chen et al, 2018;Pande & Maas, 2013). Females were underrepresented and males were overrepresented amongst physicians who were placed on the LEIE.…”

Section: Sexsupporting

confidence: 72%

Two Paths, One Destination: A Demographic Portrait of Physicians Sanctioned by the Federal Government

Burton¹,

Sun²,

Jesilow³

et al. 2022

Journal of Health and Human Services Administration

View full text Add to dashboard Cite

show abstract

“…This finding coincides with the findings of the 2018 study by Chen et al, which found that physicians who were excluded from Medicare and state public programs due to fraud were commonly male physicians. 5 Moreover, a retrospective, cohort study of 2251 malpractice claims reported to the Ophthalmic Mutual Insurance Company from 1990 to 2008 found that men were sued 54% more often than females over the period studied, indicating a prevalence of claims against men in not only medical fraud, as observed in this study, but also medical malpractice. 10…”

Section: Discussionsupporting

confidence: 56%

“…Chen et al previously examined the characteristics of physicians from all specialties who were excluded from US Medicare and state public programs for fraud, health crimes, or unlawful prescribing of controlled substances. 5 Excluded physicians tended to be older, male, and/or osteopathic physicians. The most common specialties were family medicine, psychiatry, internal medicine, anesthesiology, surgery, and obstetrics/gynecology.…”

Section: Introductionmentioning

confidence: 99%

Fraud Claims Filed Involving Practicing Ophthalmologists from 1985 Through 2020

Sharma¹,

Watane²,

Cavuoto³

et al. 2023

OPTH

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Introduction Like all United States physicians, ophthalmologists may be implicated in lawsuits claiming fraudulent medical practice. In order to educate, raise awareness, and mitigate fraudulent practice, we reviewed a legal database and analyzed fraud claims in ophthalmology lawsuits. Methods A retrospective legal literature review was performed on jury verdicts and settlements from the online legal database LexisNexis Academic from 1985 through 2020 that were filed by or against an ophthalmologist, involved a fraud claim, and included a final decision or settlement. Cases were evaluated for factors including demographics of plaintiffs and defendants, type of fraud claim, ophthalmologist party status (plaintiff or defendant), decision outcome, and amount awarded (when applicable). Results Of the 27 cases analyzed, all ophthalmologist defendants involved were male and the most common sub-specialty for an ophthalmologist defendant was refractive surgery. The most common fraud type was a fraud claim involving a malpractice lawsuit (12 of 27), followed by contract fraud and billing fraud. While the ophthalmologists in malpractice-related fraud cases experienced more rulings in favor of the defendant on the fraud claims (8 of 12), ophthalmologists in billing fraud cases experienced fewer rulings in their favor (0 of 5). Discussion Ophthalmology lawsuits involving fraud claims occurred in various settings, including malpractice lawsuits, contract cases, and Medicare and Medicaid billing. Defendants were all male and most commonly refractive surgeons.

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“…Patients need to bear the time and health cost of repeated discharge and hospitalization, resulting in poor medical experience and low PBBMI. Some scholars believe that these unreasonable medical behaviors are related to the lack of the BMIS regulatory system and regulatory tools ( 65 ). Although Harbin has followed national policies regarding supervision measures such as legislation, multi department coordination, social integrity system construction, and information construction in recent years, these methods are still in the preliminary exploration stage and need to be gradually improved.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China

Wang

et al. 2023

Front. Public Health

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BackgroundThe perceptions of the benefits of the basic medical insurance system among the insured not only reflect the system's performance but also the public's basic medical insurance policy literacy, valuable information for countries that have entered the stage of deepening reform. This study aims to examine the factors that affect the perceptions of the benefits of the basic medical insurance system in China, diagnose the key problems, and propose corresponding measures for improvement.MethodsA mixed method design was used. Data for the quantitative study were obtained from a cross-sectional questionnaire survey (n = 1,045) of residents of Harbin who had enrolled for basic medical insurance system. A quota sampling method was further adopted. A multivariate logistic regression model was then employed to identify the factors influencing the perceptions of the benefits of the basic medical insurance system, followed by semi-structured interviews with 30 conveniently selected key informants. Interpretative phenomenological analysis was used to analyze the interview data.ResultsApproximately 44% of insured persons reported low perceptions of benefits. The logistic regression model showed that low perceptions of the benefits of the basic medical insurance system was positively correlated with the experience of daily drug purchases (OR = 1.967), perceptions of recognition with basic medical insurance system (OR = 1.948), perceptions of the financial burden of participation costs (OR = 1.887), perceptions of the convenience of using basic medical insurance for medical treatment (OR = 1.770), perceptions of the financial burden of daily drug purchases costs (OR = 1.721), perceptions of the financial burden of hospitalization costs (OR = 1.570), and type of basic medical insurance system (OR = 1.456). The results of the qualitative analysis showed that the key problem areas of perceptions of the benefits of the basic medical insurance system were: (I) system design of basic medical insurance; (II) intuitive cognition of the insured; (III) rational cognition of the insured; and (IV) the system environment.ConclusionsImproving the perceptions of the benefits of the basic medical insurance system of the insured requires joint efforts in improving system design and implementation, exploring effective publicity methods of basic medical insurance system information, supporting public policy literacy, and promoting the health system environment.

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Characteristics of Physicians Excluded From US Medicare and State Public Insurance Programs for Fraud, Health Crimes, or Unlawful Prescribing of Controlled Substances

Cited by 12 publications

References 19 publications

Two Paths, One Destination: A Demographic Portrait of Physicians Sanctioned by the Federal Government

Two Paths, One Destination: A Demographic Portrait of Physicians Sanctioned by the Federal Government

Fraud Claims Filed Involving Practicing Ophthalmologists from 1985 Through 2020

Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China

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