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January 21, 2011


Robert L. Abell

Since Medicare, as do private insurers, requires certification of medical necessity for any test or procedure for which a doctor or hospital requests reimbursement, the submission of such requests, where in fact they are not medically necessary and simply an instance of "defensive medicine," by mail constitutes mail fraud and online submission constitutes wire fraud. They are also false claims to Medicare. I have no sympathy for the calls for medical malpractice reform;but if the claims of widespread "defensive medicine" are true it is also and shockingly true that that mail and wire fraud on a systemic day-by-day basis is an entrenched component of medical practice in this country.

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