It is becoming clear that a fair percentage of the health care community, particularity outside of the United States, are uncomfortable using the word, “fraud.” Instead, you see the words "risk" and "error" used more often to describe fraud.
There appear to be many different reasons for the discomfort with the word fraud. The two primary reasons are:
- Many or all of the doctors in a region are employees of the state (public servants) and are not fee for service. So they are not only less able to appropriate large amounts of money from their position in medical community, but also many countries are very hesitant to openly provide negative commentary of their government workers.
- Some medical associations have more authority and influence in certain regions. Clearly medical associations (like the AMA, American Medical Association) all have a tremendous amount of influence. However, in some regions it is even more significant, to the point where doctors are considered to be so significant as to be beyond reproach. Clearly not all Health care fraud is orchestrated by doctors, but to say none is, is simply an act of denial.
The conflict arises when health care organizations are aware that outright fraud exists but are unable to call it such, and are therefore unable to address it directly. This greatly limits their ability to prevent or pursue illegal health care activities. Clearly doctors are worthy of respect, they are highly educated and perform a significant public service.
But then that raises the question are they immune from scrutiny? At what point does the significance of the majority (good doctors) safeguard the aberrant behavior of the minority?