Crime is a topic that is often discussed among
law-makers as well as members of the general public. That being said, there is
an overwhelming focus on street crimes (e.g., theft, drug offences). Those
crimes which occur in professional settings are not given as much attention. In
this paper, one particular type of occupational crime is discussed. Medical
crime is a type of occupational crime which includes a wide range of illegal
activities committed within the medical profession. Some of these include
fee-splitting, taking or offering kickbacks, price-fixing, fraudulent billing,
and performing unnecessary operations that can cause serious harm. Minimal
oversight and unsuitable punishment enable medical professionals to take
advantage of their positions. As a result, medical crime is perpetuated. Due to
the severity of the harm caused by these crimes and the lack of oversight in
the medical profession, medical crime is arguably the most harmful type of
occupational crime.
The term “occupational crime” refers to crimes that are committed within the
context of a legitimate occupation, typically with the objective of financial
gain. Occupational crimes include retail, legal, academic, religious, and
medical crime (Friedrichs 2010:97). The focus of this essay is on medical
crime, which includes a wide range of illegal activities committed within the
medical profession. Some common medical crimes are fee-splitting, taking or
offering kickbacks, price-fixing, fraudulent billing, and perform- ing
unnecessary operations (Friedrichs 2010:
102-103). This essay considers how medical professionals undermine the integrity
of the medical profession by taking advantage of their positions and violating
the trust of the public, the serious harm caused by unnecessary surgeries, and
how medical crime is perpetuated due to minimal over- sight and unsuitable
punishment. These three points are discussed in order to demonstrate that
medical crime is the most harmful type of occupational crime.
The College of Physicians and Surgeons of Ontario states that, “medicine is
about compassion, service, altruism, and trustworthiness.” Although this
sentiment may be shared in principle, the actions of some medical professionals
suggest that it might fall by the wayside in practice. Medical professionals
enjoy a relatively high level of respect from the general public and are not
typically associated with the term “criminal.” Their high status and shield
from the criminal label allow them to engage in criminal activities without
being suspected and with only a slim chance of being caught. When doctors do
take advantage of their position of power and violate public trust for personal
gain, it undermines the integrity of the medical profession as a whole.
Healthcare is a business, and doctors might be
primarily motivated by profit. When this is the case, they may use their
respect- able status to engage in fraudulent activities. Fraud involves an
intentional deception that an individual makes, knowing that doing so could
result in some benefit (i.e., personal financial gain). Fraud by physicians
often occurs within the context of regular occupational activities, so it is
not easily discovered (Friedrichs 2010: 103). Types of fraud committed by
medical professionals include billing for services not rendered, up-coding,
misrepresenting services, and providing un- necessary treatment. The primary
victims of medical fraud are insurers, employers, and the public. Fraud results
in less money available for the deserving, the potential of physical harm, and
reduced coverage (Friedrichs 2010: 104). Furthermore, Price and Norris (2009)
note that “when medical providers bill for services never rendered, they create
a false medical history for patients that may later cause them difficulty in
obtaining disability or life insurance policies” (286). It is clear that
fraud is a major problem in the medical profession, as reflected in the fact
that “Canadian doctors were forced to pay back nearly $25 million in improper
medical insurance billings from 2010 to 2013” (The Associated Press 2015).
To demonstrate the severity of medical fraud, I
use the example of Dr. Farid Fata. Here, Dr. Farid Fata, a cancer doctor, prescribed
$35 million worth of unnecessary chemotherapy to more than 500 patients, some
of which did not even have cancer (Sterbenz 2015). This resulted in insurance
companies paying more than $17 million (The Associated Press 2015), not to
mention the physical and psychological pain inflicted on the victims and their
families. Fata admit- ted that he was being greedy and that he intentionally
misused his power for personal gain. However, Dr. Fata is not the only doc- tor
to engage in these types of activities – he just happens to be one who was
caught. When situations like this come to light, people might realize that doctors
do not all have good intentions, which may cause them to be more skeptical of
medical professionals in general. Therefore, when public trust is violated by
one doctor, the entire medical profession suffers.
When considering doctors who are more concerned with profit than the well-being
of their patients, one can turn to power theories of crime in order to suggest
an explanation for their actions. Power theories of crime argue that
criminality is more pronounced among the powerful and privileged because they
aspire to material success (Friedrichs 2010:
225). Medical professionals occupy powerful positions in society and often
enjoy a large salary. Those who are financially motivated might take advantage
of their respectable positions in order to exploit unsuspecting patients. In an
effort to maximize their profits, they may resort to criminal activity knowing
that the chance of being caught is low. This explains why fraud is not an
uncommon occurrence among medical professionals. Therefore, the medical profession
is often regarded as trustworthy and altruistic, but individuals who take ad-
vantage of their power and violate public trust for their own benefit undermine
its integrity. The financial, physical, and psycho- logical harm caused by
these criminal actions highlight the severity of medical crime and demonstrate
that it is perhaps the most harmful type of occupational crime.
Medical crime becomes violent when doctors perform unnecessary surgeries. Ac-
cording to Leape (1989), “unwarranted surgery represents a problem of
staggering magnitude in terms of needless pain, suffering, and death, as well
as a substantial waste of human and financial resources” (351). Considering the
time, effort, cost, and risks involved with any surgery, one might not suspect
that surgery would be performed unless absolutely necessary. However, unnecessary surgeries account for 15-20% of operations performed annually in the
United States (Friedrichs
2010: 103). The most common forms of unnecessary surgery are the removal of
tonsils, hemorrhoids, appendixes and uterus's, heart-related surgery, and cesarean sections (Friedrichs 2010: 103).
A look at the latter types of surgery on this list demonstrate that doctors are
willing to put their patient’s lives at risk when they perceive some personal
benefit for doing so. These are complicated surgeries with many risks that
involve an extensive recovery process. Performing unnecessary surgeries can
result in direct costs to the victims such as paralysis, blindness, or other
forms of permanent injury (Friedrichs
2010: 103). For this reason, the performance of unnecessary surgery raises many
ethical questions.
Victims of violent medical crimes also suffer
psychological costs. Most individuals hold medical professionals to a higher
standard of competence and perhaps morality than regular people. When an
individual is victimized by a doctor, they might become confused, anxious, and
suspicious of all medical professionals. As a result, victims might be less
likely to seek medical help in the future because they are scared of being
victimized again. Therefore, it is clear that being a victim of violent medical
crime can have negative consequences lasting for the rest of one’s life.
In order to try and explain why medical professionals
perform unnecessary surgeries despite being aware of the potential consequences
for patients, rational choice theory can be considered. Rational choice theory
suggests that individuals make rational decisions after considering the costs
and re- wards of a potential action (Friedrichs 2010: 233). A doctor could be aware
of the risks involved with a surgery, as well as the chances of getting in
trouble if something goes wrong. However, if they think about the potential benefits and
decide that they are greater than the risks, performing the surgery might look
like a good option. Friedrichs (2010) points out that unnecessary surgery is
promoted by the “fee-for-service” reimbursement system and the absence of
effective control mechanisms (103).
Furthermore, medical professionals might be
influenced by other doctors. Differential association theory is a learning
theory suggesting that criminal behavior is learned through contact with others
with a law violating orientation (Friedrichs 2010: 235). Doctors might be
around other medical professionals who they see getting away with medical
crimes such as the performance of un- necessary surgeries. If these other
doctors are being reinforced for their behavior by obtaining some benefit
without being punished, the observing doctor might decide that he or she too
can get away with similar activities. When deciding whether or not to commit
the crime, a doctor might engage in neutralization. Most white collar offenders
are unlikely to support the behaviors of conventional offenders and they
conform to most laws (Friedrichs 2010: 237). They are not typically “bad”
people, so they may have to suspend their beliefs about right and wrong in
order to perform a surgery that could harm their patient.
One problem that arises with the performance of
unnecessary surgeries is that they are not always easy to identify. Most people
would trust the decision of a trained medical professional because few people
have sufficient knowledge to suggest alternative courses of action. This
problem persists in the courtroom, when judges have to decide whether or not
the actions of a doctor are criminal. Judges likely do not have extensive
medical knowledge and might be unable to determine whether or not an operation
was necessary. It would likely be hard for a judge
to come up with alternative courses of action, so they might make their
decision based on their perception of the doctor’s integrity as opposed to the
situation that led to the alleged unnecessary surgery. A judge might rely on a
doctor’s expertise and rule that he or she was acting with good intentions and
is not to blame for the consequences of the surgery. This demonstrates that
people trust the decisions of medical professionals when they might be wrong,
simply because they do not have the knowledge to question them. If doctors are
aware of this, they might use it to their ad- vantage, knowing that no one will
question their decisions and that no one will be able to prove that a better
decision could have been made. Perhaps if the actions of medical professionals
were more closely monitored, the frequency of medical crimes would decrease.
Therefore, medical professionals can be the
perpetrators of violent crime in the form of unnecessary surgeries, which can
be dangerous and potentially life-threatening to their patients. The physical
and psychological costs for the victims are serious and long-lasting. The fact
that many people, including judges, accept the decisions of these doctors
because there is no one to prove that they were made selfishly is an- other
problem that facilitates the commission of violent medical crime. For these reasons,
medical crime may very well be the most harmful type of occupational crime.
Medical crime is perpetuated because there is a
lack of oversight in the medical profession and a lack of sufficient punishment
for those who do engage in criminal activities. White collar crime in general
is less visible than conventional forms of crime and offenders often go undetected.
This is also the case for medical crime, and when of- fenders are caught, they
often get out of paying the price for their actions.
As a result of systemic bias in the criminal
justice system, offenders who are members of minority groups, those who are not
well- educated, and the poor, often face harsh punishments for their crimes. On
the other hand, white collar offenders, who are typically well-educated,
upper-middle class and Caucasian men, are often met with leniency by the
justice system. This relates to medical crime because the majority of doctors
in the United States fall into the second category. In fact, of the 18,078
medical school graduates in the United States in 2014, 10,458 were White (Association
of American Medical Colleges 2015). As a result of differential opportunity
between social groups within society, those who are able to attend medical
school often come from well-off families. Therefore, the majority of new doctors
are prime examples of individuals who have a greater chance of lenient
treatment by the criminal justice system. For this reason, they might be
encouraged to engage in medical crime because they know that they are likely to
get away with it.
Citing an example used earlier, Dr. Fata, the cancer
doctor, only received 45 years in prison for unnecessarily treating and harming
over 500 patients – thus showing how those within the medical profession are
more likely to receive a lenient sentence when compared to others (The
Associated Press 2015). Furthermore, lawyers might argue that when a doctor is
given a criminal label, it ruins their reputation. Arguing that a medical
professional has suffered enough as a result of the humiliation that comes with
being labeled a criminal might evoke sympathy in the courtroom and could lead
to a lesser sentence.
The law favors those with power and influence,
which explains why medical professionals might be treated more leniently. In
one case, “the court held that simple lack of care, error of judgment, or an
accident is not proof of negligence on the part of a medical professional”
(Pandit & Pandit 2013: 379). It is also a possibility that people, including
members of the criminal justice system, do not want to think that medical
professionals would engage in criminal activities. These individuals likely all
visit a doctor as well, and knowing that they could be a victim of medical
crime might create a sense of uneasiness. Pandit and Pandit (2013) said that: “when a legal notice is
received or a consumer case alleging deficiency in service is filed against a
doctor, it creates a lot of emotional disturbance as the reputation of medical
professionals is built over years through sheer hard work, expertise, and skill
acquired by strenuous training and investment over the years” (383).
It might be hard for individuals to accept that
their doctor, someone who they trust with their health, could be a criminal.
Perhaps for this reason, they try to avoid labeling them as such in order to
maintain their own peace of mind.
The fact that doctors are able to use their
respectable positions to engage in crime can be related to the routine activities
theory. This theory suggests that crime is a consequence of motivated
offenders, suitable victims, and the absence of guardians (Friedrichs 2010:
234). As mentioned earlier, medical professionals might be motivated by profit
and will engage in illegal activities in order to obtain some benefit. This is
relatively easy for them because they enjoy autonomy in their decisions and
they often deal with vulnerable patients who do not ask any questions. The lack of
oversight in the medical profession gives these individuals the opportunity to
do essentially whatever they want. Therefore, the motivated offenders, suitable
victims, and lack of a control mechanism provide the perfect opportunity for a
doctor to engage in criminal activities with- out being caught. Perhaps if more
controls were imposed on medical professionals and their actions were more
closely monitored, the frequency of medical crimes would decrease.
Therefore, the autonomy granted to medical
professionals and the lack of sufficient punishment facilitates the commission
of medical crimes and will continue to do so until more is done to regulate the
behavior of doctors and hold them accountable for their actions. The fact that
the conditions in the medical profession perpetuate the commission of medical
crime given the detrimental physical and economic costs, demonstrates that
medical crime is a serious problem and is possibly the most harmful type of
occupational crime.
In conclusion, medical crime is a serious form of
occupational crime that undermines the integrity of the medical profession, can
result in physical and psychological consequences for victims of unnecessary
surgery, and is perpetuated by a lack of control over the decisions of medical
professionals and a lack of punishment for those who are caught. After
considering these aspects of medical crime, it can be concluded that medical
crime is the most harmful type of occupational crime.
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