Healthy Skepticism Library item: 9031

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Publication type: news

Nader C.
Unethical doctors to face jail
The Age (Melbourne) 2007 Mar 27
http://www.theage.com.au/news/national/unethical-doctors-to-face-jail/2007/03/26/1174761379908.html?page=fullpage#conten

Full text:

DOCTORS who accept bribes from pathologists could face up to five years in jail and large fines under a Federal Government crackdown.

Reforms planned to be introduced to Parliament this week will also make it easier to prosecute pathologists who offer financial and other incentives to doctors in return for having patients sent their way.

The move follows concerns about the soaring cost of pathology services, and claims that this might be partly linked to doctors ordering tests on patients in returns for bribes or other inducements from pathologists.

Pathology tests now cost the health system about $1.5 billion a year, compared to $1.09 billion in 1999-2000.

The law changes mean that doctors will for the first time face prosecution for accepting inducements from pathologists. Criminal sanctions would apply if it can clearly be established that they ordered tests from a pathology provider because of an incentive, and civil sanctions would apply in other cases.

Pathologists, who can already face criminal prosecution under existing law, will now face the additional threat of civil sanctions. This is designed to open another avenue of prosecution when it has been difficult to prove a clear link between doctors accepting gifts and the inappropriate ordering of pathology tests. The changes will also apply to diagnostic imaging.

While the changes come amid concerns of over-servicing, it is not clear whether this is responsible for the jump in blood tests and other tests doctors are ordering. Concerns that doctors are vulnerable to litigation if they incorrectly diagnose a patient are also believed to have contributed to more tests being ordered.

A spokeswoman for Health Minister Tony Abbott said the changes would specify that it was unlawful to offer or receive inducements of this nature – regardless of whether it can be shown that the intention was to encourage over-servicing.

The Government will introduce a bill amending the Health Insurance Act. Civil penalties start from $56,000 for individuals and $660,000 for corporations. The maximum criminal penalty is a five-year jail term, although a court can choose to impose fines of $33,000 for individuals or $165,000 for corporations.

The Government flagged a tougher approach to the sector last June, when it released the results of a review, conducted by lawyers Phillips Fox. The Government indicated at the time it would accept most of the recommendations.

The review reported allegations from members of the pathology industry of doctors being offered inflated rent, gifts of “considerable value” and lump sum payments. Pathology providers also told of doctors who “actively solicit inducements, gifts and benefits”.

The report authors said they had not tried to substantiate the validity of the claims. “Nevertheless, the frequency and consistency of claims made across the sector generates a high level of confidence that such conduct is, in fact, occurring,” they said.

There were also claims that inducements were being offered to doctors by third parties on behalf of pathology services, and gifts may be provided to spouses of doctors who asked for them.

Tougher penalties were welcomed by Australian Association of Pathology Practices president Michael Guerin. “There’s always one rotten apple in the bottom of the barrel, and the AAPP is very keen to create the level playing field and most pathology practitioners in fact play the fair game,” he said.

Australian Medical Association president Mukesh Haikerwal was more cautious. “If prosecution is to be pursued then there has to be a good legal basis for that,” he said. “An investigative process needs to be thorough and fair.”

The report said that while only a minority of pathology providers were believed to engage in inappropriate conduct, there was a perception the law had no teeth, as there had been no prosecutions since the early 1990s.