Although there is no reason medical professionals should be immune from the corruption that afflicts others, these are not cases one would expect to find in the stereotypical venues of graft such as Russia, or Third World countries. One would not expect to encounter them in the West - and certainly not in the United States.

Think again. The self-anointed global centre of healthcare excellence has just been exposed as a hive of corruption and greed, a country where hundreds of hospitals every day cheat insurers and patients as routinely as they oversee the taking of a pulse.

When President Bill Clinton tried to transform the nation's private healthcare system into something resembling what critics scorn as 'socialised' systems of Canada and Europe, his main purpose was to protect 50 million Americans now without insurance.

Lost were concerns about the inherently anti-Hippocratic climate of a system geared to value profits above healing.

While lobbyists for the multi-billion-dollar healthcare industry swarmed around Capitol Hill to get the reforms defeated, few concerns were voiced about a culture in which patients had become products and doctors had to do the bidding of shareholders.

But the worst excesses of some of the nation's biggest hospital operations have come to light in recent weeks, and the biggest sufferer of all has turned out to be the American taxpayer. Large-scale fraud involving hospitals and the nation's Medicare programme has taken the issue beyond a matter of medical ethics to one that touches the viability of America's long-term economy.

Medicare, which costs the treasury US$200 billion (nearly HK$1,550 billion) a year, provides free health care to all senior citizens, regardless of their income.

Signs have been emerging since the turn of the decade that a demographic crisis is approaching as the large numbers of baby boomers prepare to retire.

But demographics is not the only culprit. The system whereby doctors and hospitals claim the costs of treating the elderly back from the Government is so convoluted and porous that cheating has become institutionalised.

One recent report estimated that in one year alone fraudulent claims cost Medicare US$23 billion - one-tenth of its budget and comparable to the GDP of Bangladesh.

Congress began to recognise the problem about two years ago, allotting US$500 million for investigations of offenders.

The most prominent casualty so far - taxpayers aside - is the nation's most powerful healthcare company: Columbia/HCA, once an upstart little firm that has grown like Topsy in 10 years to the the point where it runs 350 hospitals in the US, and enjoys an annual US$1.5 billion profit.

Federal agents, tipped off by whistle-blowing company executives, recently raided several of its hospitals, carting away mountains of incriminating evidence of false claims and over-billing.

The fact that the probe has centred on Florida, where several Columbia executives have been arrested and indicted, is probably no coincidence. As home to the highest proportion of wealthy retirees, Florida is also a magnet for hospitals wanting to cash in on Medicare-funded treatment.

That is why the organisation, during its unstoppable expansion drive in the 1990s, invested heavily by buying up more than 30 hospitals in the Sunshine State.

One indictment alleges that in just one Columbia hospital, Medicare claims defrauded taxpayers of more than US$1.7 million.

Columbia's once-stellar share price has dropped 25 per cent since the probe became public. Fat-cat pension funds have invested heavily in health care, and one of Columbia's larger shareholders, the New York State pension fund, has filed a lawsuit claiming damages from the plunge in stock value allegedly caused by Columbia fraud.

Columbia's co-founder, Richard Scott, recently quit the scandal-racked firm and, although he has not so far been implicated, it seems likely he created the climate of greed that allowed illegal activity to take place. He set high profit targets for each hospital and left administrators and doctors to achieve them however they could.

Economic analysts are convinced Medicare is going to imperil America's balance of payments in the next decade. The recent balanced-budget deal - hailed by Democrats and Republicans alike as a historic act of fiscal responsibility - contained no measures to rein in the galloping costs of Medicare. Political fear of 'grey power' anger torpedoed an attempt to raise from 65 to 67 the minimum age for Medicare eligibility.

So as to concentrate on their job of healing patients, it would seem many of America's physicians need to start by healing themselves.