Case Vignettes Used in Ethics Survey

Terminally ill patients

Poor patient

The patient is terminally ill. He says he has used his son’s medical insurance to get care because he could not afford insurance and did not qualify for Medicare or Medicaid. He was recently laid off from a custodial job and has only been able to find part-time work.

Previous fraud

The patient is terminally ill. He says he has used his brother’s medical insurance because he could not afford insurance and did not qualify for Medicare or Medicaid. He has a previous conviction for health insurance fraud.

Wealthy patient

The patient is terminally ill. He says he has used his brother’s medical insurance. He states that although he could have afforded medical insurance (being a successful business consultant), it was financially more beneficial to use his brother’s instead.

Acutely ill patients

Poor patient

The patient has recently recovered from an acute illness and is now in stable health. The patient says he has used his brother’s medical insurance to get care because he could not afford insurance and did not qualify for Medicare or Medicaid. He was recently laid off from a custodial job and has only been able to find part-time work.

Previous fraud

The patient has recently recovered from an acute illness and is now in stable health. He says he has used his brother’s medical insurance because he could not afford insurance and did not qualify for Medicare or Medicaid. He is known to have committed health insurance fraud in the past.

Wealthy patient

The patient has recently recovered from an acute illness and is now in stable health. He says he has used his brother’s medical insurance at another hospital. He states that although he could have afforded medical insurance (being a successful computer programmer), he wanted to save money by using his brother’s insurance instead.

Source: Farber NJ, Berger MS, Davis EB, et al. Confidentiality and health insurance fraud. Arch Internal Med 1997; 167(3):501-504.