What's behind doctors' decisions to illegally raid Medicare?

Am I imagining things, or are doctors now raiding Medicare out of desperation? Is the $375 million Medicare/Medicaid fraud scheme allegedly masterminded by Dr. Jacques Roy in Dallas an isolated incident or just the tip of the iceberg?

Roy and his co-conspirators are charged with certifying hundreds of fabricated claims a day and pocketing the loot in the single greatest bilking in public insurance history.

Why am I not surprised?

Is it cynical to suggest that a clear cut criminal who certifies fake services to 500 home health agencies and then allegedly banks the money in the Cayman Islands under a fake name may be motivated by more than just sociopathic behavior and greed?

Is it obscene to suggest that anger and frustration are also playing a role here and played a role as well in the $240 billion billing scheme of 2011 where 115 doctors, nurses, executives, and other workers were charged? What about the scheme involving 91 criminals who generated $290 million in false billings?

How easy is it to turn to a life of crime when Medicare and Medicaid continue to decrease a doctor’s reimbursements even as office expenses soar?

Don’t get me wrong, I still believe in the Hippocratic Oath and the Oath of Maimonides and I still believe in working for the sheer challenge and passion of helping patients. But I am greatly concerned that too many physicians are cutting corners in ways that aren’t as obvious or as clearly criminal as Dr. Roy and his cohorts appear to be.

What about an extra EKG or an Xray or a Cardiac Echo that doesn’t really need to be done? Where is the disincentive for over-ordering of tests and procedures or even doctors’ visits beyond just simple integrity?

Clearly a line is crossed once a physician is billing for services that are never delivered, but what about the grey areas along the way? Once your integrity is compromised by greed, should you still be practicing medicine?

I say emphatically no. Though I am sympathetic to those of my fellow physicians who must see more and more patients in a single day to pay their bills, I also believe that any doctor who sacrifices his or her integrity should not be practicing medicine.

Medicare cuts should not be aimed at physicians but at overuse of non-essential services. Doctors should be paid more - not so that we keep our hands clean - but so that we can afford to keep our doors open.

Marc Siegel MD is an associate professor of medicine and Medical Director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A Team and author of "The Inner Pulse; Unlocking the Secret Code of Sickness and Health."