Court offensive against easy prescriptions
DECISIVE PARAMETERS The Guardia di Finanza activated by the Region disputes the deviation from the average expenditure of the Healthcare Company
Yes
Healthcare expenditure under observation. With doctors in the crosshairs, the "recipes" as the indictment and the "Minerva theorem" to sharpen the weapons of the controls. From Lombardy to Calabria, the cases of doctors investigated by the regional prosecutors of the Court of Auditors as hyperprescribers are multiplying: that is, they would be under observation for having the prescription "too easy" and, above all, too expensive. Lombardy seems to be, for now, the epicenter of the investigations by the Guardia di Finanza (564 suspected doctors against a total of about 7,000, just to give an idea of the extent of the disputes), with 220 registered letters sent throughout haste in 2007 to as many doctors to block the statute of limitations of the action for tax compensation for conduct dating back to 2002. Now all the doctors placed on the stand find themselves having to remedy justifications for drugs prescribed even some ago.
What is certain is that the damage that could have occurred to the state coffers is enormous and the Public Prosecutor's Office, based on the requests, has quantified it at 25 million euros. Without, for now, any repercussions on the criminal level: we are, therefore, far from the hypotheses of crimes such as fraud against the state.
Also in Campania and Calabria there are many open proceedings and a small emergency is reported by the local Courts of Auditors. But the convictions are few, while the transactions are more frequent, often closed for much lower figures than those initially requested (again a Lombard case: a doctor agreed to pay 14,000 euros against an initial dispute of 124,000 ), confirming the fact that the discretion in the prescription of medicines is not a very easy principle to undermine. So much so that, recently, in Calabria, the case of 24 doctors accused of prescribing drugs too lightly was filed because the evidence was deemed insufficient to base the accusation in the trial.
On the other hand, in 2004 two doctors were sentenced by the Court of Auditors of Umbria, at the request of the prosecutor Massimiliano Minerva (for a total of approximately 1 million and 200 thousand euros), against whom responsibility for tax damage caused by the 'having excessively prescribed medicines paid for by the National Health Service. A pilot sentence in its own way, which has since made school by opening a new season for the verifications in the studies by the ASL.
The ruling, in fact, bases the sanction on the relevance of the deviation of the prescriptions signed by the two Umbrian doctors, almost double, compared to the average of the patients assisted by the local health authority. The information system set up by the ASL was able to reconstruct the complete path of each prescription by the affiliated general practitioners, starting from the delivery of the recipe book to the compilation of each single prescription to its forwarding by the pharmacy where the prescription is purchased drug, to the same Health Authority for reimbursement by the National Health Service.
A system, however, not very different from that envisaged in other Local Health Authorities and in other Regions. Where each general practitioner periodically receives a report (here at the side an example of a model received from a healthcare provider in Lombardy) with which he is informed of his own activity and, item by item, of any deviations from the average of the Healthcare Company.
A practice that should avoid nasty surprises for white coats, but which does not convince them at all. m
