Doctors' Chisel

For a dozen years, the California Medical Association has been mighty proud of its insurance plan for paying part of the cost of doctors' bills. With 820,000 subscribers and more than $18 million paid out in their behalf last year, the California Physicians' Service is one of the nation's largest and most successful private medical plans. As such, it is offered as a working-model argument against state medicine. Last week C.P.S. was shocked to its bone marrow: 200 or more doctors had been gypping the plan by charging it for services they had never rendered. The swag was estimated at $1,000,000 to $1,200,000 a year.

Sometimes the doctors billed C.P.S. for operations which were not performed and office calls that were never made. One chiseler made the crude mistake of sending in a bill for surgery and office calls while the patient was actually in New York. Others got higher fees by raising the category of their work--e.g., charging for a cataract operation instead of merely draining a sty. There was wholesale chiseling by charging for imaginary X rays and laboratory tests.

C.P.S. trustees, worried by longtime whispers, had canvassed a large group of patients, and all too often found the whispers justified. Now, in any case where gouging is suspected, the doctor's bill is audited before he gets paid. The trustees hope that, now that the racket has been exposed, the guilty doctors will mend their ways. C.P.S. would prefer not to sue them, but if it has to, it will.

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