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September 20, 2000

Should Physicians Manipulate Reimbursement Rules to Benefit Patients?

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1382-1383. doi:10.1001/jama.284.11.1378

To the Editor: Dr Wynia and colleagues1 found that physicians sometimes manipulate reimbursement rules to benefit patients, themselves, or both. When reimbursement rules are bent, the physician always benefits.

Under fee-for-service arrangements, common manipulations include unnecessary hospitalizations and additional hospital days, higher levels of coding of services, or alleging nonexistent pathology to justify cosmetic procedures. Each of these actions increases income for the physician.