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April 15, 1992

Physician Fraud and Medicaid

Author Affiliations

Columbus-Cabrini Medical Center Chicago, Ill

JAMA. 1992;267(15):2037. doi:10.1001/jama.1992.03480150043026

To the Editor.  —The article "Fraud by Physicians Against Medicaid" by Jesilow et al1 is seriously misleading. Its main conclusion, appearing in the abstract, is that "sanctioned physicians show an overrepresentation of psychiatrists, foreign medical graduates, and minority group physicians." The text of the article does not substantiate this conclusion. The authors do not, in fact, provide additional information other that of 138 physicians, sanctioned by Medicaid between 1977 and 1982, slightly more than one third were international medical graduates; blacks and psychiatrists were also overrepresented.The key issue here is the term overrepresentation. As the article stands, it leaves the impression that these minority physicians cheat more than their mainstream counterparts. Representation, however, or representativity, can only be defined with regard to a population. If the population is that of all physicians, then one third of international medical graduates would indeed be disproportionate. It is known, however, that