When medical referrals go too far

by | Feb 27, 2019 | Uncategorized

It is true that much of what goes on in the healthcare business is based on credibility, networking and word of mouth. However, there is also a great deal of money in the industry that comes directly from the government.

Doctors and hospital workers get plenty of perks, and people appreciate the work they do. They may even get gifts from patients and business partners. Additionally, physicians work within this network to refer patients to specialized care. Why does all this matter when it comes to government funds?

Government money represents public interest

The government has an interest in keeping everyone healthy. At times, public tax money goes towards subsidizing healthcare. This is good — as long as the providers behave ethically and make sure patients get the best care possible.

Private referral networks could subvert public health

Some doctors in the past have seen the healthcare industry’s dependence on referrals as a way to keep patients within a closed system. While this does not necessarily result in poorer care, it could be an ethical and legal violation in many cases. In short, doctors are not supposed to refer to offices in which they have an economic interest. 

By the same token, healthcare companies are not supposed to exchange valuable items or money for patient referrals. Medical care should, ideally, be recommended based on the necessity for the care and quality of the provider, not for any physician’s personal gain.

Individuals often do not follow the same rules as networks

In an industry in which insurance companies largely determine where patients may receive care, it may be hard to see the line between acceptable referral practices and illegal behavior. Unfortunately, medical offices do not have the same professional regulations as insurance companies. 

Discovering closed networks of mutually financially beneficial referrals could easily lead to a worker getting fired. Speaking up against kickbacks may also cost someone his or her job. Therefore, it is important to contribute to the quality of healthcare in a way that may not damage professional prospects, such as via a whistleblower or qui tam suit.