Doctors who lose their license in one state regularly set up practice in others with ease, according to federal officials, who told state regulators attending a conference here that they are not doing enough to control dangerous, unlicensed and fake doctors.
"There's a total lack of quality control," said David Syr, who led the U.S. Postal Inspections fraud investigation of U.S. doctors who bought fake degrees from Caribbean medical schools. "If you're upset that the federal government may intrude, why aren't you outraged [by the lack of controls]?"
Syr and others said the problems include lax discipline of unfit doctors, poor reporting between hospitals, boards and regulators, and scant disclosure to the public.
It still is common practice for doctors to surrender their license in one state during a disciplinary proceeding and move to another and set up practice, officials said.
"No one stops them," said Dr. Salvatore Mangano, former chairman of the Massachusetts Board of Registration in Medicine. "The hospitals plea-bargain with doctors to shove them out of their territory."
The military, state institutions and some federal agencies, such as the Veterans Administration, have become havens for doctors who have lost their licenses or who have questionable medical credentials, Mangano said.
The National Federation of State Medical Boards, in response to criticism that many unfit doctors dodge discipline by moving from state to state, has converted its files on 10,000 disciplined doctors into a nationwide computerized bank.
But although the network includes only final actions by government bodies, the public will be unable to use it.
"It's set up just for the other boards," said Dr. Bryant Galusha, the federation's executive vice-president, who said the Defense Department now is reporting to the network the names of its doctors who have had licenses revoked.
Over the years, state regulators have complained that they have had trouble obtaining reports from the American Medical Association's Physician Masterfile, a similar network. With the increased attention to doctor discipline, the AMA is volunteering to be of service to the state boards.
The Council of State Governments has set up a network in Louisville to track disciplinary actions against all professional license holders, but only about 20 medical boards are cooperating by sending cases to this National Clearinghouse on Licensure, Enforcement and Regulation (CLEAR).
Because of soaring health-care costs and malpractice claims, the federal government, large corporations and health insurers also are exerting new pressure to identify unfit doctors.
In a four-year pilot study nearing completion, the Department of Health and Human Services found that in one state, 271 doctors without a proper license received $8.5 million in three years for Medicare-patient care and $384,000 in Medicaid.
"Bogus doctors are submitting claims from Medicare," said Dr. Kenneth Nelson, medical adviser to the HHS Office of Inspector General. "Individuals whose licenses are revoked continue to practice without apparent concern."
Nelson would not name the state, but said he believes that doctors in every state who have lost their license routinely keep billing the government for payment.
Congress is taking steps to stop this. A bill has passed the House and is awaiting Senate action to ban doctors from federal programs once they lose their license in any state.
Nelson said the Health Insurance Association of America, the Washington Business Group on Health and other organizations that pay medical bills now are trying to determine whether they are paying claims to those without a license.
Emphasizing that the federal government wants doctor discipline to remain a state duty, Donald Foster, deputy director of the Justice Department's fraud section, noted that more federal prosecutions of unlicensed doctors would occur if state legislatures would make the crime a felony.