POLICING PHYSICIANS: PRACTITIONER FRAUD AND ABUSE IN A GOVERNMENT MEDICAL PROGRAM*

Fraud and abuse by physicians participating in government medical programs incurs physical and fiscal costs to society. This paper focuses on the enforcement process by which such behavior is detected, defined, and sanctioned. Interviews with officials in California's Medi-Cal program reveal the special problems associated with the influence of physicians' professional power on the enforcement process. In addition, the occupational status of physicians protects them against damaging interpretations of acts that may be in violation of the law.