While filing my 1996 NEJM, I noticed an interesting letter to the editor: “Compensation of Lawyers and Doctors.” Richard G Williams, MD, from Suisun, California, reflects on seeing two lawyers. The first was his own attorney who charges Dr. Williams $185 per hour.. The second attorney was a patient. whose health maintenance organization pays Dr Williams $156 to provide comprehensive medical care for an entire year. Dr Williams concludes: “An hour of legal work is now worth more than a year of medical care.”

By a narrow margin of six votes, delegates at the June AMA meeting approved new ethical guidelines for selling nonprescription, health-related products in a physician’s office. Critics of the guidelines took opposite stances—some declared the guidelines were too rigid; others cried that they were too lenient.

Using the report of the Council on Ethical and Judicial Affairs (CEJA) (which called for an almost total ban of such sales in the office) as a basis for its decisions, the House ended up taking a middle-of-the-road position. The guidelines laid down for selling nonprescription, health-related products, including nutritional supplements, safety devices, and skin-care products are summed up as follows: the physician 1) must validate the product’s medical efficacy; 2) offer the products to his patients free or at cost; 3) must not participate in distributorships where products are available only through doctors’ offices; and 4) let their patients know, in full, about their financial arrangements with the manufacturer or supplier and also the availability of similar products elsewhere.

Stephen Grossman, MD, continues to dialogue about “Fraud and Abuse” in Vital Signs, the monthly bulletin of the Fresno-Madera Medical Society. His previous article was so abrasive that it was relegated to the “Letters to the Editor” page. (Dr Hinsdale, president of the Santa Clara Society warned us not to talk with friendly Medical Board investigators–see VOM last issue). Dr Grossman received so many positive responses to his “abrasive letter” that he was asked to write “Round Two.” He points out that Janet Reno has made Fraud and Abuse in health care the number one priority for white-collar crime. Our patients are being tracked through our UPIN number to investigate our bills, labs, and DMEs. He points out that most physicians do not fully appreciate that an erroneous statement sent through the US Mail is MAIL FRAUD with penalties of $10,000 per line item error. In an undercover FBI sting, an officer posing as a patient asked the doctor on the way out to sign a form for diapers for his grandmother who was to become a patient the next week. The FBI returned the next day with guns and badges for charges of failure to do a good faith exam, conspiring to defraud the government (over diapers), signing a form on a patient that did not even exist. Another colleague in Fresno got a $53,000 fine and accepted it rather than fight it. Dr Grossman fears when they implement the new [AMA & HCFA] E & M codes: “GOD help us all.”