Two Paths,One Destination: A Demographic Portrait of Physicians Sanctioned by the Federal Government

Abstract

There is scarce information about the institutional mechanisms creating the demographic portrait of sanctioned doctors published in the U.S. Office of Inspector General's (OIG) List of Excluded Individuals and Entities (LEIE). The current study examines the demographic characteristics of 1,289 physicians who appeared in the LEIE during a five-year period from 2008 to 2013. The results of a multivariate logistic regression found that sex, country of medical school training, and medical specialty were associated with being excluded by the OIG for a quality of care matter. Findings suggest the demographic portrait of doctors in the LEIE reflects the interplay between the doctors’ behaviors and the actions of various agencies. A demographic portrait of physician violators, if one considers the mechanisms generating the list, can be useful for public policy recommendations and action.

Keywords

Deviant Doctors List of Excluded Individuals and Entities Medicare Office of Inspector General

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References

Adler

(1975). Sisters in crime: The rise of the new female criminal. New York: McGraw-Hill.

Administration for Community Living. (2021). 2020 profile for older Americans. https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2020ProfileOlderAmericans.Final_.pdf.

Agresti

(2002). Categorical data analysis, second edition. John Wiley and Sons.

Aldrich

(2011). Medicare fraud estimates: A moving target? The Sentinel. 21–24. https://www.smpresource.org/Handler.ashx?Item_ID=41776DC6-D448-4C90-BD1A-45C2DCF2EE03.

Allyn

(2021). The Elizabeth Holmes trail is sparking a gender debate in Silicon Valley. NPR. https://www.npr.org/2021/09/24/1040353540/the-elizabeth-holmes-trial-is-sparking-a-gender-debate.

American Medical Association; (2018). Timeline of women in medicine. https://www.ama-assn.org/delivering-care/health-equity/timeline-women-medicine.

Association of American Medical Colleges. (2020). 2020 physician's specialty data report. https://www.aamc.org/data-reports/data/2020-physician-specialty-data-report-executive-summary.

Association of American Medical Colleges. (2021). AAMC report reinforces mounting physician shortage. https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage.

Avraham

(2019). Database of state tort law reforms (DSTLR 6th). Law & Economics Research Paper Series, Paper No. e555. Austin: University of Texas School of Law. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=902711.

10.

Becker

, Hall

, & Stinson

(2001). Female sexual offenders: Clinical, legal and policy issues. Journal of Forensic Psychology Practice, 1(3), 29–50. https://doi.org/10.1300/J158v01n03_02.

11.

Benson

M. L.

, & Gottschalk

(2015). Gender and white-collar crime in Norway: An empirical study of media reports. International Journal of Law, Crime and Justice, 43(4): 535–552. https://doi.org/10.1016/j.ijlcj.2015.01.001.

12.

Boston

, & Cimpian

(2018). Here's how to encourage more girls to purse science and math careers. The Conversation. https://theconversation.com/heres-how-to-encourage-more-girls-to-pursue-science-and-math-careers-98229.

13.

Campaniello

(2019). Women in crime. IZA World of Labor. https://doi.org/10.15185/izawol.105.v2.

14.

Chen

, Blumenthal

D. M.

, & Jena

A. B.

(2018). Characteristics of physicians excluded from US Medicare and state public insurance programs for fraud, health crimes, or unlawful prescribing of controlled substances. JAMA Network Open, 1(8), e185805. doi:10.1001/jamanetworkopen.2018.5805.

15.

Choudhry

N. K.

, Fletcher

R. H.

, Soumerai

S. B.

(2005) Systematic review: The relationship between clinical experience and quality of health care. Annals of Internal Medicine, 142(4). 260–273. https://doi.org/10.7326/0003-4819-142-4-200502150-00008.

16.

Clay

S. W.

, & Conatser

R. R.

(2003). Characteristics of physicians disciplined by the State Medical Board of Ohio. The Journal of the American Osteopathic Association, 103(2), 81–88. https://pubmed.ncbi.nlm.nih.gov/12622353/.

17.

Commins

(2015). 35 Texas counties have zero physicians. Health Leaders. https://www.healthleadersmedia.com/strategy/35-texas-counties-have-zero-physicians.

18.

Congressional Research Service, (2021). U.S. health care coverage and spending. https://sgp.fas.org/crs/misc/IF10830.pdf.

19.

Cunningham

, & May

(2006). Medicaid patients increasingly concentrated among physicians. Tracking Report, 16, 1–5. https://pubmed.ncbi.nlm.nih.gov/16918046/.

20.

Currie

(2015). The roots of danger: Violent crime in global perspective. Oxford University Press.

21.

Daly

(1989). Gender and varieties of white-collar crime. Criminology, 27(4), 769–794. https://doi.org/10.1111/j.1745-9125.1989.tb01054.x.

22.

Denov

(2004). Perspectives on female sex offending: A culture of denial. Hampshire, England: Ashgate Publishing.

23.

Dodge

(2019) Women and White-Collar Crime. Oxford Research Encyclopedia of Criminology. https://doi.org/10.1093/acrefore/9780190264079.013.493.

24.

Dodge

, & Geis

(2003). Stealing dreams: A fertility clinic scandal. Northeastern University Press.

25.

Dow

W. H.

, & Harris

D. M.

(2002). Exclusion of international medical graduates from federal health-care programs. Medical Care, 40(1), 68–72. https://doi.org/10.1097/00005650-200201000-00009.

26.

Eisenmann

T. R.

, & Nielson

, (2009) Sermo survey. Harvard Business School. https://hbsp.harvard.edu/product/809142-PDF-ENG?activeTab=overview&itemFindingMethod=Exclusion of Certain Individuals and Entities from Participation in Medicare and State Health Care Programs, 42 U.S. Code § 1320a-7. https://www.law.cornell.edu/uscode/text/42/1320a-7.

27.

Federal Bureau of Investigation (2021). Health care fraud: Common scams and crimes. https://www.fbi.gov/scams-and-safety/common-scams-and-crimes/health-care-fraud#Report-Fraud.

28.

Feldmeyer

(2009). Immigration and violence: The offsetting effects of immigrant concentration on Latino violence. Social science research, 38(3), 717–731. https://www-sciencedirect-com-443.web.bisu.edu.cn/science/article/pii/S0049089X09000209.

29.

Fordyce

M. A.

, Doescher

M. P.

, Chen

F. M.

, and Gary Hart

(2012). Osteopathic physicians and international medical graduates in the rural primary care physician workforce. Family Medicine-Kansas City, 44(6), 396–403. PMID: 22733416.

30.

Frais

S. M.

, & Angel

R. J.

(2005). The risk of partner violence among low-income Hispanic subgroups. Journal of Marriage and family, 67(3), 552–564. https://www-jstor-org.web.bisu.edu.cn/stable/3600188.

31.

Galvin

M. A.

(2020). Gender and white-collar crime-Theoretical issues. Criminal Justice Studies, 33(1), 61–69. https://doi.org/10.1080/1478601X.2020.1709954.

32.

Hagopian

, Thompson

M. J.

, Kaltenbach

, and Hart

L. G.

(2004). The role of international medical graduates in America's small rural critical access hospitals. The Journal of Rural Health, 20(1), 52–58. https://doi.org/10.1111/j.1748-0361.2004.tb00007.x.

33.

Heiligers

(2012). Gender differences in medical students' motives and career choice. BMC Medical Education, 12, 82. https://doi.org/10.1186/1472-6920-12-82.

34.

Iezzoni

L. I.

, Rao

S. R.

, DesRoches

C. M.

, Vogeli

& Campbell

E. G.

(2012). Survey shows that at least some physicians are not always open or honest with patients. Health Affairs, 31(2), 383–391. https://doi.org/10.1377/hlthaff.2010.1137.

35.

Iglehart

J. K.

(2001). The Centers for Medicare and Medicaid Services. The New England Journal of Medicine, 345, 1920–1924. https://doi.org/10.1056/NEJM200112273452617.

36.

Jena

A.B.

, Seabury

, Lakdawalla

, & Chandra

(2011). Malpractice risk according to physician specialty. The New England Journal of Medicine, 365(5), 629–636. https://www.nejm.org/doi/full/10.1056/nejmsa1012370.

37.

Jesilow

, & Burton

(2017). Detecting Healthcare Fraud and Abuse in the United States. In Oxford Research Encyclopedia of Criminology and Criminal Justice, Ed. Lenard

Ben

. New York: Oxford University Press. https://doi.org/10.1093/acrefore/9780190264079.013.275.

38.

Jesilow

, & Burton

(2017b). Constructing a demographic portrait of deviant doctors. In Sefiha

& Brown

(Eds.), Handbook of deviance studies (pp. 472–485). Anderson/Routledge Press. https://doi.org/10.4324/9781315648057.ch40.

39.

Jesilow

, Burton

, & Sun

(2022). Healthcare fraud. In Huebner

B. M.

(Ed.), Oxford Bibliographies in Criminology. Oxford University Press. https://doi.org/10.1093/OBO/9780195396607-0157.

40.

Jesilow

, Geis

, Pontell

, & Song

J. H. L.

(1992). Culture conflict revisited: Fraud by Vietnamese physicians in the United States. International Migration, 30(2), 201–224. https://doi.org/10.1111/j.1468-2435.1992.tb00693.x.

41.

Jesilow

, & Ohlander

(2010). The impact of the National Practitioner Data Bank on licensing actions by state medical licensing boards. Journal of Health and Human Services Administration, 33(1), 94–126. https://www-jstor-org-443.web.bisu.edu.cn/stable/25790776?seq=1#metadata_info_tab_contents.

42.

Jesilow

, Pontell

H. N.

, Geis

(1993). Prescription for profit: How doctors defraud Medicaid. The Regents of the University of California Press.

43.

Kaiser Family Foundation. (2021). Status of sate action on the Medicaid expansion decision. https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?activeTab=map&currentTimeframe=0&selectedDistributions=status-of-medicaid-expansion-decision&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

44.

Khaliq

A. A.

, Dimassi

, Huang

C. Y.

, Narine

, & Smego

R. A.

Jr (2005). Disciplinary action against physicians: Who is likely to get disciplined? The American Journal of Medicine, 118(7), 773–777. https://doi.org/10.1016/j.amjmed.2005.01.051.

45.

Kohatsu

N. D.

, Gould

, Ross

L. K.

, & Fox

P. J.

(2004). Characteristics associated with physician discipline: A case-control study. Archives of Internal Medicine. 164 (6), 653–658. https://doi.org/10.1001/archinte.164.6.653.

46.

Lambert

E. M.

, & Holmboe

E. S.

(2005). The relationship between specialty choice and gender of U.S. medical students, 1990–2003. Academic Medicine, 80(9), 797–802. https://doi.org/10.1097/00001888-200509000-00003.

47.

Landman

(2022). Why well-qualified medical school graduates can't get jobs – despite doctor shortages. Vox. https://www.vox.com/22989930/residency-match-physician-doctor-shortage-pandemic-medical-school.

48.

Lee

M. T.

, & Martinez

Jr. (2009). Immigration reduces crime: An emerging scholarly consensus. Sociology of Crime, Law and Deviance, 13, 3–16. https://doi.org/10.1108/S1521-6136(2009)0000013004.

49.

Leigh

J. P.

, Tancredi

, & Jerant

(2010). Physician wages across specialties: Informing the physician reimbursement debate. JAMA Internal Medicine, 170(19). https://doi.org/10.1001/archinternmed.2010.350.

50.

Marani

, Katul

G. G.

, Pan

W. K.

, & Parolari

A. J.

(2021). Intensity and frequency of extreme novel epidemics. Proceedings of the National Academy of Sciences, 118 (35). https://doi.org/10.1073/pnas.2105482118.

51.

McAvinue

M. B.

, Boulet

J. R.

, Kelly

W. C.

, Seeling

S. S.

, & Opalek

(2005). US citizens who graduated from medical schools outside the United States and Canada and received certification from the Educational Commission for Foreign Medical Graduates, 1983–2002. Academic Medicine, 80(5), 473–478. https://doi.org/10.1097/00001888-200505000-00015.

52.

McGrath

, & Zimet

C. N.

(1977). Female and male medical students: Differences in specialty choice selection and personality. Journal of Medical Education, 52(4), 293–300. https://pubmed.ncbi.nlm.nih.gov/845911/.

53.

McIntyre

D A.

, (2020). These Are the 218 Counties Without a Doctor. 24/7 Wall St. https://247wallst.com/healthcare-economy/2020/04/22/these-are-the-218-counties-without-a-doctor/.

54.

McMahon

G. T.

(2004). Coming to America: international medical graduates in the United States. New England Journal of Medicine, 350(24), 2435–2437. https://doi.org/10.1056/NEJMp038221.

55.

Morrison

, & Wickersham

(1998). Physicians disciplined by a state medical board. JAMA, 279(23), 1889–1893. https://doi.org/10.1001/jama.279.23.1889.

56.

Nagarajan

K. K.

, Bali

, Malayala

S.V.

, & Adhikari

(2020). Prevalence of US-trained International Medical Graduates (IMG) physicians awaiting permanent residency: a quantitative analysis. Journal of Community Hospital Internal Medicine Perspectives, 10(6), 537–541. https://doi.org/10.1080/20009666.2020.1816274.

57.

National Conference of State Legislatures. (2017). Combating health care fraud, waste and abuse: Health cost containment. NCSL Briefs for State Legislators. https://www.ncsl.org/research/health/combating-health-care-fraud-and-abuse.aspx.

58.

Office of Inspector General (2021, August). Applying for reinstatement. https://oig.hhs.gov/exclusions/reinstatement.asp.

59.

Office of Inspector General (2021, August). Background information. https://oig.hhs.gov/exclusions/background.asp.

60.

Office of Inspector General (2021, August). Exclusions FAQ: Answers to questions concerning exclusions. https://oig.hhs.gov/faqs/exclusions-faq.asp.

61.

Ousey

G. C.

, & Kubrin

C. E.

(2018). Immigration and crime: Assessing a contentious issue. Annual Review of Criminology, 1(1), 63–84. https://www.annualreviews.org/doi/abs/10.1146/annurev-criminol-032317-092026.

62.

Pande

, & Maas

(2013). Physician Medicare fraud: Characteristics and consequences. International Journal of Pharmaceutical and Healthcare Marketing, 7 (1), 8–33. https://www.emerald.com/insight/content/doi/10.1108/17506121311315391/full/html.

63.

Pontell

H. N.

, Jesilow

, Geis

, & O'Brien

M. J.

(1985). A demographic portrait of physicians sanctioned by the federal government for fraud and abuse against Medicare and Medicaid. Medical Care, 23(8), 1028–1031. https://www-jstor-org-443.web.bisu.edu.cn/stable/3764973?seq=1#metadata_info_tab_contents.

64.

Raypole

(2022). Gender bias in healthcare is very real – and sometimes fatal. Healthline Medical Network. https://www.healthline.com/health/gender-bias-healthcare.

65.

Sampson

R. J.

, Morenoff

J. D.

, & Raudenbush

(2005). Social anatomy and racial and ethnic disparities in violence. American Journal of Public Health, 95(2), 224–232. https://doi.org/10.2105/AJPH.2004.037705.

66.

Sanderson

J. P.

(1856). The views and opinions of American Statemen on foreign immigration. Philadelphia: J.B. Lippincott and Co.

67.

Schaffer

A. C.

, Jena

A. B.

, & Seabury

S. A.

(2017). Rates and characteristics of paid malpractice claims among US physicians by specialty, 1992–2014. JAMA Internal Medicine, 177(5), 710–718. https://doi.org/10.1001/jamainternmed.2017.0311.

68.

Sampson

R. J.

(2008). Rethinking crime and immigration. Contexts, 7(1), 28–33. https://doi.org/10.1525/ctx.2008.7.1.28.

69.

Simon

R. J.

(1975). Women and crime. Lexington, MA: Lexington Books.

70.

Smart

(2012). Physician characteristics and distribution in the United States. American Medical Association.

71.

Sparrow

M. K.

(1998). Fraud control in the health care industry: Assessing the state of art. National Institute of Justice Research Brief. https://www.ojp.gov/pdffiles1/172841.pdf.

72.

StataCorp. (2021). Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.

73.

Statista Research Department. (2021). Share of old age population (65 years and older) in the total U.S. population from 1950 to 2050. https://www.statista.com/statistics/457822/share-of-old-age-population-in-the-total-us-population/.

74.

Steffensmeier

D. J.

, Schwartz

, & Roche

(2013). Gender and twenty-first-century corporate crime: Female involvement and the gender gap in Enron-era corporate frauds. American Sociological Review 78(3), 448–476. https://doi.org/10.1177/0003122413484150.

75.

United States Census Bureau (2021). Zip code tabulation areas (ZCTAs). https://www.census.gov/programs-surveys/geography/guidance/geo-areas/zctas.html.

76.

Van Slyke

S. R.

& Bales

W. D.

(2013) Gender dynamics in the sentencing of white-collar offenders. Criminal Justice Studies 26(2), 168–196. https://doi.org/10.1080/1478601X.2012.729707.

77.

Whelan

G. P.

, Gary

N.E.

, Kostis

, Boulet

J. R.

, & Hallock

J. A.

(2002). The changing pool of international medical graduates seeking certification training in US graduate medical education programs. JAMA, 288(9), 1079–1084. https://doi.org/10.1001/jama.288.9.1079.

78.

World Health Organization. (2022). Global health workforce statistics database https://www.who.int/data/gho/data/themes/topics/health-workforce.

79.

Young

, Chaudhry

H. J.

, Pei

, Arnhart

, Dugan

, & Snyder

G. B.

(2017). A census of actively licensed physicians in the United States, 2016. Journal of Medical Regulation, 103(2), 7–21. https://www.fsmb.org/siteassets/advocacy/publications/2016census.pdf.