Reasons for Disclosure in the Physician-Patient Relationship
How Physician Conduct and Reimbursement Methodologies Lead to Fraud and Abuse in Medicare
The solvency of the Medicare Trust Fund has been debated for the past twenty-five years and despite various stop-gap measures, fraud and abuse continues. Public policy in the form of Stark legislation, anti-kickback laws, and false claims acts were enacted to reduce over-utilization of services and prohibit self-referral and inducements for patients and services.
Despite public policy and continued prosecution of fraud, Medicare reimbursement methods fail to control physician conduct of over-utilization and inducements for referrals.
Following the concept of the informed consent doctrine and the theory of fiduciary trust in the patient-physician relationship, it is the author's thesis that transparency and disclosure with respect to physician prescription and referral practices can mitigate the over-utilization problem.