Role of deception grows in obtaining coverage

Exaggeration’ becoming more common

Almost 40% of physicians say they have exaggerated a patient’s condition to an insurance company to make sure the patient has coverage for needed treatment or time in the hospital, according to a recent survey conducted by the American Medical Association (AMA) in Chicago.

"Physician deception of third-party payers is prevalent and may be rising," according to AMA investigators.

The most common forms of deception include:

• exaggeration of severity of the patient’s condition in order to avoid early discharge from the hospital;

• changing the billing diagnosis to help secure services;

• reporting symptoms the patient did not have in order to obtain coverage and treatments.

Overall, 39% of physicians reported that they had "sometimes," "often," or "very often" used one of the three forms of deception, according to the 1998 survey of 724 doctors in primary care medicine.

Only 28% of physicians said they had never used any of these forms of deception within the last year, and 53% reported they "rarely" used them.

In addition, 37% of physicians reported that their patients asked them to deceive third-party payers, and this was the group of physicians that was most likely to have used deceptive strategies.

Some 31% of physicians had "sometimes" or more often refrained from offering useful or needed services to patients because of a lack of coverage by the patient’s plan.

The data were collected by the AMA from its survey of physicians on "Meeting Patients’ Needs in the Modern Era."

The report also found physicians who reported using deceptive strategies were:

— less satisfied with the practice of medicine;

— less financially secure themselves;

— less likely to try to talk patients out of unnecessary procedures;

— more dissatisfied with the amount of time available during patient visits;

— more likely to voice annoyance at intrusion of insurance companies into their practice.

Overall, 55% of physicians said they "would be more aggressive in cost control efforts if they knew that money saved would go towards serving more needy patients."

"While physicians’ use of deception may benefit individual patients, using deception may also damage the patient-physician relationship, cause moral discomfort for physicians, subvert resource allocation systems, and risk prosecution for fraud," researchers concluded.