I seriously doubt it. Doctors have always had gentleman's agreements to refer patients to each other, and then refer the patient back once the specialist is done.

The only kind of payola that I've ever seen after 14 years in health care are drug companies purchasing cruises/lovely dinners, etc... for doctors.

It depends on the type of doctor, and the type of service. For example, dentists and oral surgeons use referral kickbacks almost 100% of the time. I've seen xray specialists and open-MRI centers also offer doctors kickbacks.

It's obviously not seen in HMOs and in emergencies or in large hospital institutions, but in the private medicine arena, where this guy is solely practicing, it certainly is more common than you make it seem.

Of course. That's how the game is played.