Are Insurance Companies Effectively or Politically Immune From Criminal Prosecution?

There is a double standard in our society when it comes to criminal prosecution of wrongdoing. The conduct of individuals — outside of the corporate context — is immediately subjected to investigation and prosecution when criminal conduct is afoot, but when criminality happens behind the walls of the corporate Palaces of America, things just seem to magically stall. Even the famed Erin Brockovich pointed out just recently that if a person poured poison into the water well of his neighbor, we would promptly hear clicking handcuffs. But if a corporation deliberately poisons drinking water . . . .

Insurance companies are quick to shout out the word “fraud” and do not hesitate to speak the language of criminal prosecution. They use these types of threats against doctors who they would like to intimidate into making changes to their patient care (i.e., billing). But what about when the insurance companies engage in criminality? Who is there to be the watchdog for the doctors and medical providers when health insurers act unlawfully or even criminally? There are 50 State Insurance Commissioners, each responsible to supervise the conduct of insurers in their States. But many do not seem to have criminal prosecutorial authority. While they can investigate conduct and threaten to pull an insurer’s license to operate in their State, such a measure is a rare occurrence indeed.

So who, then, is the protector of doctors, hospitals, and other medical providers when health insurers act unlawfully or criminally? At a minimum, there are United States District Court judges, appointed by the President for life terms, untethered by politics, who can hear and determine cases brought by either federal prosecutors or by private parties using the Civil RICO law or other laws. It remains to be seen which prosecutors or private parties have the courage and grit to penetrate the walls of the Palaces.

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