If we’re looking for the source of our troubles we shouldn’t test people for drugs, we should test them for stupidity, ignorance, greed and love of power.” –P.J. O’ Rourke

Fraud is distinguished from negligence, ignorance, and error by virtue of the fact that it is Intentional; involving some level of calculation.¹ Negligence is: “the failure to use such care as a reasonably prudent and careful person would use under similar circumstances,”  and characterized chiefly by “inadvertence, thoughtlessness, inattention, and the like.”².  Fraud, in contrast, is not accidental in nature, nor is it unplanned.^2-4 Those who commit fraud know what they are doing and are deliberate in their efforts. They are also aware that it is unethical, illegal, or otherwise improper.

Fraudulent intent  can be established by examining the documentation of decisions and behaviors associated with those involved. As explained in Coenen: “Manipulation of documents and evidence is often indicative of such intent. Innocent parties don’t normally alter documents and conceal or destroy evidence.”⁵

A chain of custody is generated in real time. It cannot be done retroactively. To do so constitutes fraud.   What is remarkable is with what apparent ease this was done.  There is no compunction, concern or inquiry from top to bottom at either of these agencies and documents a Machiavellian egocentricity. The acts are those of morally disengaged bullies who lack compassion and integrity.

One would assume that the state of Massachusetts would have a low tolerance for forensic fraud in the wake of the Annie Dookhan lab scandal,  especially when the perpetrators are contractors with the Department of Public Health (DPH) and work within the walls of the Massachusetts Medical Society (MMS).

The problem is Physician Health Programs (PHPs) have set up procedural barriers designed to bloc, ignore, marginalize and bury.  Truth is misrepresented, censored and suppressed.  The DPH and MMS have no oversight or regulation over Physician Health Services (PHS) and PHPs have convinced law enforcement that doctors police themselves.

Accountability needs to be rooted in organizational purpose and public trust.  When an organization operating within or contracting with an institution is committing  serious misconduct and fraud, then it becomes the institutions responsibility to investigate and correct it.  How low must the moral compass go before the MMS and DPH recognize what is self-evident to everyone else?   This would not have happened 20 years ago. What is happening to the profession of medicine when the institutions that are supposed to represent physicians and the public health allow individuals who are obviously and inexcusably engaging  in behavior antithetical to their own expressed ideals and purpose?

Corrupt individuals cannot be hired or retained by an employer without some level of institutional negligence, apathy or even encouragement.

Rationalization involves either self-delusion regarding the acceptability of fraud related to behavior under “special circumstances” or a disregard for the law as unjust or somehow inapplicable.⁵ Coenen explains that rationalization is the process by which someone   “determines that the fraudulent behavior is “okay” in her or his mind. For those with deficient moral codes the process of rationalization is easy. For those with higher moral standards it may not be quite so easy; they may have to convince themselves that a fraud is okay by creating “excuses” in their minds.

There is a diffusion of responsibility when verification is required and repercussions warranted.  This system of institutional injustice and forensic fraud between state Physician Health Programs and these corrupt labs is occurring across the country. I have spoken to the spouses and parents of multiple doctors who have killed themselves because this same thing was done to them.  Their deaths are being caused by people just like this and accountability is needed.

 

1. Albrecht WS, Albrecht CO. Fraud Examination and Prevention. Mason, Ohio: South-Western Educational Publishing; 2003.
2. Black HC. Black’s Law Dictionary. 6th ed. St. Paul, Minnesota: West Group; 1990.
3. Albrecht WS, Albrecht CO, Albrecht CC, Zimbelman MF. Fraud Examination. 4th ed. Mason, Ohio: South Western Cengage Learning; 2011.
4. O’ Lord A. The Prevalence of Fraud . What should we as academics be doing to address the problem? Accounting and Management Information Systems. 2010;9(1):4-21.
5. Coenen T. Essentials of Corporate Fraud. Hoboken, NJ: John Wiley & Sons, Inc.; 2008.

 

 

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