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March 8, 2000

Fairness in Fraud and Abuse Enforcement

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(10):1289-1290. doi:10.1001/jama.283.10.1287

To the Editor: Dr Sage1 concludes that the best advice for physicians is to "do what is best for your patients, think twice before accepting free money, and don't sign anything you don't understand." While the first and second items are straightforward, it is very difficult in the current environment to avoid signing things one does not understand. I am in private, solo practice of orthopedic spinal surgery. In addition to signing more than 35 dictated chart notes a day, cosigning a physician assistant's notes, and signing 10 drug refills daily, I am faced with signing multiple forms certifying the necessity for durable medical equipment and physical therapy. These forms are covered with exceedingly small writing by various medical care providers, and simply cannot be read in the time allotted. Failing to sign these, however, limits my patients' access to physical therapy or much-needed walkers or wheelchairs. At least 40 of these forms cross my desk each week.

I am reminded of a friend who was an officer on a nuclear submarine undergoing overhaul. He was faced with a choice of following all the regulations and never getting the ship completed or signing off on those parts of the inspection that he felt could safely be omitted regardless of regulation. Unfortunately, we have come to a similar point in the treatment of patients, and I believe patients do not suffer as a result. I certainly cannot adequately police overuse of therapy or equipment, and every time I sign these forms, I worry about my liability in this regard. A belief clearly exists that physicians can be made the final scapegoat for everyone else's responsibility to do the right thing for the patient.

Sage  WM Fraud and abuse law.  JAMA. 1999;282:1179-1181.Google Scholar