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Article
February 9, 1994

Prescription for Profit: How Doctors Defraud Medicaid

Author Affiliations

The University of Chicago (Ill)

 

by Paul Jesilow, Henry N. Pontell, and Gilbert Geis, 247 pp, $25, ISBN 0-520-07614-1, Berkeley, Calif, University of California Press, 1993.

JAMA. 1994;271(6):476-477. doi:10.1001/jama.1994.03510300088050

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Abstract

Today it seems almost trite to say that the American health care system is in chaos. If the well-known crises of soaring costs and limited access were not bad enough, this book examines yet another problem plaguing the system: Medicaid fraud.

The authors present horrifying stories. A psychiatrist billed Medicaid for 4800 hours in one year, or for almost 24 hours each workday. Other physicians billed for seeing patients who were dead. Some charged for abortions on women who were not pregnant or who even had previously undergone hysterectomy. One physician billed Medicaid for treating a 22-year-old college football player for diaper rash. The infamous inner-city "Medicaid mills" provide a venue for physicians to charge for seeing literally hundreds of patients a day while dispensing little or no care in exchange for their Medicaid fees. The authors report that fraud is thought to account for 10% to 25% of total

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