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Physicians Fudge Insurance Forms To Help Patients

MANAGED CARE May 2000. © MediMedia USA
News and Commentary

Physicians Fudge Insurance Forms To Help Patients

MANAGED CARE May 2000. ©2000 MediMedia USA

A study confirms what has long been considered common but is rarely discussed: Physicians often lie about patients' conditions to gain or improve coverage for their treatment.

According to the Journal of the American Medical Association, 39 percent of doctors admit to upcoding, changing billing diagnoses, or reporting nonexistent symptoms. While the authors acknowledged these practices, they are not, they wrote, a systematic effort to deceive insurers. But, they added, as cost-control pressures increase, "gaming the system" is more likely to occur.

It wasn't clear from the study whether physicians' tactics were entirely altruistic. Physicians most likely to fudge insurance forms include those with a Medicaid patient base of 25 percent or more — perhaps, the authors speculated, to make up for Medicaid's relatively low reimbursement rates. Most respondents said they were not in a position to gain from the most common reason for deceiving insurers: to get patients into the hospital.