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Medical claims processing industry --- Health insurance claims --- Medical records --- Electronic data interchange --- Computer networks --- Electronic Data Processing. --- Computer Communication Networks. --- Insurance Claim Reporting. --- Insurance, Health. --- Medical Records. --- Data processing --- United States.

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Long-term care facilities --- Finance --- Extended care facilities --- Health facilities --- Hospitals --- Long-term care of the sick --- After care --- Finance. --- Clinical Coding --- Insurance Claim Reporting. --- Skilled Nursing Facilities. --- methods. --- Facilities, Skilled Nursing --- Nursing Facilities, Skilled --- Extended Care Facilities --- Care Facilities, Extended --- Care Facility, Extended --- Extended Care Facility --- Facilities, Extended Care --- Facility, Extended Care --- Facility, Skilled Nursing --- Nursing Facility, Skilled --- Skilled Nursing Facility --- Claim Reporting, Insurance --- Reporting, Insurance Claim

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In this explosive exposé of our health care system, Paul Jesilow, Henry N. Pontell, and Gilbert Geis uncover the dark side of physician practice. Using interviews with doctors and federal, state, and private officials and extensive investigation of case files, they tell the stories of doctors who profit from abortions on women who aren't pregnant, of needless surgery, overcharging for services, and excessive testing.How can doctors, recipients of a sacred trust and sworn to the Hippocratic Oath, violate Medicaid so egregiously? The authors trace patterns of abuse to the program's inauguration in the mid 1960s, when government authorities, not individual patients, were entrusted with responsibility for payments. Determining fees and regulating treatment also became the job of government agencies, thus limiting the doctors' traditional role. Physicians continue to disagree with Medicare and Medicaid policies that infringe on their autonomy and judgment.The medical profession has not accepted the gravity or extent of some members' illegal behavior, and individual doctors continue to blame violations on subordinates and patients. In the meantime, program guidelines have grown more confusing, hamstringing efforts to detect, apprehend, and prosecute Medicaid defrauders. Failure to institute a coherent policy for fraud control in the medical benefit program has allowed self-serving and greedy practitioners to violate the law with impunity.Prescription for Profit is a shocking revelation of abuse within a once-hallowed profession. It is a book that every doctor, and every patient, needs to read this year.

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