PHYSICIANS: One-Third Lie to Insurers to Help Patients
To help their patients get the care they need, 39% of national doctors said they "sometimes" have exaggerated the severity of an illness to help patients avoid early hospital discharge, listed inaccurate diagnoses on bills and reported nonexistent symptoms, according to a new study in today's Journal of the American Medical Association. Additionally, 37% said their patients "sometimes" or more often had asked them to deceive insurers. Twenty-nine percent indicated that "gam[ing]" the system is necessary to provide high-quality care. And of those who admitted deceitful practices, 54% said they had done so more often now compared to the past. The study, which encompasses responses from 720 physicians, is a follow up to an earlier study published in the AMA's Archives of Internal Medicine, which found that more than half of doctors approved of using such practices.
Lead researcher Matthew Wynia speculated on a cause: "As pressures to control health care costs increase, it is likely that manipulating reimbursement systems will increase" (AP/Washington Post, 4/12). John Fung, chief of the Division of Transplantation Surgery at University of Pittsburgh Medical Center, admitted he has engaged in such practices. He said, "Do I do it for financial gain? No, the financial penalties are tremendous, let alone the possibility of jail time and having a criminal record. We do it because we think it is right. We do it for the patients." Experts said the study results are "symptomatic of unprecedented anger among physicians." Karen Donelan, assistant professor at the Harvard School of Public Health, said, "For the last five to seven years, we have seen a growing level of frustration on the part of doctors with what they perceive as a system that has gone too far," adding that the percentage of doctors who deceive insurers is "probably an underestimate." But American Association of Health Care Providers spokesperson Laura Diamond said that doctors "have ample opportunity to discuss their concerns with a plan medical director if they feel it's necessary to get coverage instead of engaging in medical deception" (Vogel, ABC News.com, 4/11).