Characteristics of Physicians Excluded from Public Insurance Programs

Bottom Line: This study examined the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health care crimes or unlawful prescribing of controlled substances. There were 2,222 physicians (0.3 percent) excluded temporarily or permanently between 2007 and 2017 based on federal data. Exclusion rates were highest in the West and Southeast, with West Virginia having the highest exclusion rate at almost 6 per 1,000 physicians (32 exclusions among 5,720 physicians). Overall, physicians were more likely to be excluded if they were male, had osteopathic training, were older or practiced in specific specialties (family medicine, psychiatry, internal medicine, anesthesiology, surgery and obstetrics/gynecology). The study design prevents causal inferences but may help to identify characteristics associated with physicians more or less likely to engage in fraud.

Authors:  Alice Chen, Ph.D., M.B.A., M.Sc., University of Southern California, Los Angeles, California, and coauthors


To Learn More: The full study is available on the For The Media website.