Doctors Receiving Kickbacks

[Baxter]

So is it illegal for the doctor to receive a kickback or is just frowned upon?

[Arnfinn Madsen]

In general it is illegal, but the pharmaceutical companies look for loopholes, so it all ends up being grey.

[kibble420]

For more info on this topic, I highly recommend reading "Death by Prescription" as well as the widely debated Natural Cures book.

/Flame away

[onthebutton]

It used to occur on a much wider scale, and was much more tolerated than it is now. Pharma companies used to be able to pretty much do whatever they wanted (think Congressional junket style stuff). However, new restrictions have curtailed what pharma representatives can do for doctors.

Now, I'm not saying it doesn't happen, but I wouldn't say it's widespread. People who try to constantly villify Pharma (a la Michael Moore) in many cases don't have any idea what they're talking about.

[Apoc]

My gf's been a doctor for 10 years now, and the law has changed in that time as far as I know. I fondly remember the good ol' days when we would regularly get free meals at 5-star restaurants and vacations and other goodies. The government clamped down on that about 3-4 years ago, and since then, nothing. So, if the pharma companies are giving kickbacks, my gf is somehow out of the loop now. FWIW, she's in family practice, so she prescribes plenty of medicine, although not the hardcore stuff that's in the realm of specialists.

[peachy]

yes they get kickbacks for a wide assortment of things

[The Truth]

My dad is an emergency room doctor/director. Alot of this stuff isn't a direct money kick back. You don't write a prescription for xanax and get a 50 dollar check.


"Do doctors receive a kickback on prescriptions, diagnostic tests, braces, referrals, etc?"

It depends on who the doctor is working for. If the doctor is in private practice, then he could get a literal kick back (I have no experience with private practice doctors.)


Other than this option, the doctor could be paid hourly (probably through a group, but he could work directly for the hostpital). In which case, he makes no money regardless of how many tests he preforms etc. It is in his best interest to get you in and out quickly with the best service generally.

The doctor could also get paid a % of what the total charge to the patient is (this is likely in the interest of the hostpital. Do you see why?) In this case, all tests, lab work, and medicine that you take in the hostpital are included under charges. Prescription cost doesn't go to the doctor. Generally people have health insurance to cover the tests. The doctors know exactly what diagnosis they have to put down in order for each type of insurance to pay for each procedure. They must put down very broad diagnosis, if they put down something specific, the insurance won't pay for alot of the care.

Insurance is very open about trying to dodge as much of the cost as they can from each patient. I don't know the exact numbers, but the hostpital only actually collects like 60% of what they charge to the insurance. So, what you see on your bill is not what your insurance company pays. They pretty much decide what they will and won't accept.

Most of the large insurance companies change their system around each year to try to get out of paying for more and more services.

This causes the hostpitals to raise their average charge per patient to maintain the same profit. In turn, insurance trys to pay less and puts more stipulations and regulations on when and what they will pay for (they deem what they wont pay for "unnecssary" so the cost is on the hostpital).

So you have the insurance companies making the doctors job harder, and punishing the patient. The hostpital is pushing the doctor to get around the paper work of the insurance company.

The doctors that get paid a % of the total patient charge:

Now, there are doctors (even on my dads staff), that try to run as many tests as humanly possible on every patient. One guy on dads staff has a charge rate of almost double the average doctor on the staff (I used to do the patient turnover numbers and doctors average charge numbers for dad for extra money before poker).

This guy can do this because he claims he is being thorough and doesn't want to be sued. While it isn't true, there is no way to prove it. With tort law so huge these days, it can be claimed as a legit fear. In addition, this guy is buddy buddy with people high up in the group.

So now, we have insurance companies not paying full price and dodging cost. We have hostpitals increasing costs to counter. Doctors running up patient charges for maximum hourly profit.

Then a middle class working guy who doesn't happen to have insurance comes in to get a check up. Where does this leave him? Who is looking out for his interest? Do you think they have seperate charging standard for Joe than they do for blue cross? Nope, Joe pays 100% of what they charge blue cross, blue cross pays 60%.

Of the people with no insurance a doctor sees, they collect well under half of the total charges. They pretty much don't expect to get paid. People without insurance can't afford to pay medical bills. Credit trouble.

Referrals:

These can be bad. Generally, its a you scratch my back, i'll scratch yours type deal.

In the ER, alot of patients get sent to somebody else. The ER doc decides who. Whomever the ER doc sends these patients too stands to gain a good amount of money (1-10k per). When this kind of money is involved, there are going to be kickbacks.

I wouldn't say kickbacks are the standard. I would suggest its more of returning the favors in other ways. Whoever has the most pull in the town will probably get the business ultimately.

blake

Note: I am a college kid. All my numbers are off the top of my head and could be way off. Some facts may be off, a doctor could get a piece of a prescription, for instance. I don't think that is the standard though. So, take it with an understanding of my background.

[The Truth]

Oh, I forgot to include drug reps.

The doctors get taken out to nice dinners by the reps. They may get some things like tickets to a show. Pens, hats, shirts, party poker type gear that says the drug name on it.

The doctors def get attention in this way.

In general, go with generic. Not only is it cheaper, it is often better.

You can request what your doctor gives you. I wouldn't go in and say I want pain pills, but if he says he is giving pain pills; you can say you want generic or whatever.


blake

[LittleOldLady]

If you read the Physician's portrait in the Canterbury Tales, you will see that purveyors of pharmaceuticals have been kicking back to physicians since at least the late 14th century, nothing new under the son.

Laws have been passed in recent years to curb kickbacks to physicians, but there is always a way if someone wants one.

When I was a girl all the ophtalmologists in my home town had their own eye glass dispensary. You had to buy your glasses from the eye doctor, paying his prices and being restricted in choice by his inventory, because the eye doctors refused to give patients their prescriptions. Therefore it was impossible to go to a competing vendor. A law was passed to put a stop to that. Now we have pharmaceutical companies underwriting research by physicians--and guess how that research tends to turn out. There's always a way for those that want it.

[jimmifli]

I do a lot of video work in the pharmaceutical industry in Canada (so my comments are restricted to the Canadian Health System and more specifically Ontario).

The short answer to your question is no. The rules are very strict. Doctors receive nothing for writing scripts. Reps are allowed very little wiggle room in terms of gifts and services given to physicians.

However, some GP's are in a position where they can become "opinion leaders". These doctors often receive funding from pharmaceutical companies through research grants or unrestricted educational grants. They also receive money and travel for presentations promoting certain drugs or studies.

Most physicians view drug reps as pests, and would prefer if they didn't have any contact with them.

The real issue isn't about kickbacks, it's about education. In Canada the vast majority of CME (continuing medical education) is done through the pharmaceutical companies. In other words, your doctor is learning how to treat diseases from pharmaceutical companies.