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Cutting Waste and Keeping Faith
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
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.
M. Gregg Bloche, MD, JD
Georgetown University Law Center; Washington, DC 20001
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
