Evening star., 1954-10-10
Are You Getting Your Money Medical Treatment?

split between referring phys
ician and surgeon Is acknowl-
edged but not broken down
has been widely practiced In
Iowa for Q half century"
3. 1T became known that
young ell-trained. ethical
surgeons going into the State
to establish themselves In
practice were running into
economic boycottS from uneth-
ical practitioners. Some were
told they would starve If they
didn't cut the referring physi-
clans in.''
8. In 1851 internal revenue
agents began examining the
accounts Of many Iowa doc
tors. The doctors were told
they could not deduct as busi-
ness expense any fees paid to
doctors not In their regular
employ. According to one
estimate, the doctors of Iowa
stood to lose more than three
million dollars as q result Of
this decision"
4. "The argument Of the
unfortunate doctors that the
splits paid out were a Gus
tomary and necessary expense
of business and therefore de-
ductible ran into seeming con-
f1ict with the fact that the
State of Iowa has a law de-
filming fee-splitting as unpro-
fessional conduct, an act for
which a physician may have
his license to practice re-
voked." The Iowa Attorney
General has interpreted this
law as permitting fee-splitting
If done with the patients
knowledge.
5. On the plea of Iowa ply
Sicians the Internal Revenue
Bureau indicated it would al
low the deduction Of splits
If the doctors could provide
satisfactory evidence that
combined billing with the pa
tents consent was generally
accepted and not illegal.
6. In 1852 the Iowa State
Medical Society issued two Ella
borations, placing itself in
the position Of recommending
that the referring physician
assist the surgical specialist
and go on the same unitem-
lied bill with him. The fee, to
be ,divided equitably,' could be
collected by either doctor. This,
las far as is known, constituted
the first time that a conStitu-
ent or component society of
the American Medical Associa-
ton had officially admitted
that its members split fees; in
fact. advocated that they do
So" "
7. This deadlock meant that
Iowa ACS fellows, If following
approved" practice there,
would be violating their pledge
to the ACS not to split fees.
Some doctors say there is no
reason for an able specialist
to- indulge In fee-splitting. II
a specialist is really good. hell
have more patients than he
can handle. they claim.
Others say that excellent
specialists som e times find
themselves caught up in webs
where fee-splitting has been an
accepted practice inathe COM
munity for many years. They
feel they have to go along in
order to survive although
they don't like 1t. If some were
convinced they could turn over
a new leaf and a statute Of
limitations would protect them
from investigation of the past,
they'd Immediately stop split
ting fees.
Those are problems of the
medical profession.
How to Fight It
But what can the patient do
to protect himself from fee
splitting?
You can demand separate.
itemized bills from physicians
who attend you.
You can go to the specialist
to whom your referring phySi-
clan goes himself and sends
members of his own family.
You can discuss with your
doctor the cost of a proposed
course Of treatment when pos
sible-which will make the re-
lationship a much happier af-
fair, says the ANA.
If you believe you're the
victim Of f1agrantly unethical
practice you can bring your
case before your local medical
society mediation committee.
An ANA spokesman says there
are now about 500 such COM
mittees which annually hear
an estimated Is to 20 griev-
anceS each.
If your local medical society
doesn't have a mediation COM
mittee 1t would be interesting
to find out why not.
fAs~o,tn<nA Y-n..N