INSURANCE FRAUD: Deceiving Insurers OK, MDs Say
Many physicians approve of lying to insurers or HMOs to "secure payment for treatment if patients cannot get it another way," according to a survey released this weekend at an American Medical Association conference at the University of California-Los Angeles (AP/New York Times, 10/25). As insurers have tightened "controls on access to medical treatments," physicians have begun to approve use of "incorrect or ambiguous documentation" to secure approval of treatments for their patients. Researchers conducted the survey of 169 internists in eight metropolitan areas, four largely served by managed care companies and four with a relatively low number of managed care providers. The doctors were presented with six different patient scenarios, "ranging from life-threatening conditions to cosmetic surgery." In each scenario, physicians were told that the patients could not afford the procedure and their insurer was unwilling to pay for the procedure (Reuters/Washington Times, 10/25). Among the results:
- 57.7% of doctors approved of submitting false forms to secure approval of a patient's coronary bypass;
- 56.2% approved of lying for a patient who needed surgery to open a blocked leg artery;
- 47.5% favored lying to get terminal patients intravenous pain medication;
- 34.8% would lie for a patient who needed a mammogram;
- 32.1% would lie to get a psychiatric referral;
- 2.5% would lie for a patient who wanted a nose job;
- More than 25% of physicians did not support lying under any circumstances;
- 13.6% supported deceptions in all cases except for cosmetic surgery.