Yes, the fraud and abuse laws are frustratingly complex and ambiguous. They impose large administrative burdens. Perhaps more painful for many practitioners, they embody a skeptical attitude toward professional motives and judgment. The subjectivity of many diagnostic and therapeutic coding decisions makes compliance and enforcement daunting. The threat of stiff civil and even criminal penalties can feel intimidating. Criminal prosecution has at times been overzealous [1].

Yet a wholesale attack on the concept of fraud and abuse regulation would serve the medical profession poorly. Individual practitioners can protect themselves, albeit at some cost, through conservative coding and careful documentation. The profession as a whole can best restore and preserve the public's confidence by recommitting itself, in visible ways, to the Hippocratic ideal of undivided loyalty to patients [2]. An indiscriminate, high-profile campaign against fraud and abuse regulation would risk sending the opposite signal.

Were the U.S. public utterly confident in the medical profession's immunity to financial temptation, neither Congress nor the current administration would see political advantage in the enactment and aggressive enforcement of fraud, abuse, and self-referral legislation. To attribute "antiphysician bias" to professional leaders who have perceived and struggled with the relation between bedside financial incentives and patient confidence is to mistake friend for foe, at a time when friends are much needed. And to call for the heads of editors with the foresight to identify and invite discussion of issues vital to the welfare of physicians and their patients is to attack the profession's capacity for adaptation to its rapidly changing environment.