By Brian Johnsrud
Every year, billions of dollars are raked in by providing Americans with their health needs. And for just about every disease, their seems to be an equal number of insurance companies. With different policies and customer rates, often we don't consider insurance companies the victims. Doctors, ironically, may be the ones secretly impairing your insurance provider.
A report in the Journal of the American Medical Association found an unanticipated oddity in the truthful relationship between these two medical figures.
More than a third of doctors nationwide openly admit that they lie to insurance companies to help their patents receive the care they need. The report involved 720 physicians who participated by a random mail survey taken two years ago. Some of
the most commonly used tactics most of the doctors used included: magnifying the seriousness of an illness to keep patients in the hospital instead of sending them home early, reporting nonexistent symptoms to secure insurance coverage, and listing an incorrect diagnosis on bills.
Dr. Gregg Bloche, in an editorial accompanying the survey, wrote, "The authors' findings concerning conscious deception are stunning. More than a quarter of all respondents agreed that it is necessary to game the system to provide
high-quality care."
A similar survey linked to this one asked doctors if they would deceive insurance companies, with different levels of severity for the illness. Out of 169 doctors, 58 percent they would lie for medically warranted bypass surgery, 32 percent said they could justify it for a psychiatric referral not otherwise covered, and 3 percent said they would falsify the need for cosmetic nose surgery.
Another variety of this has been more narrowed down and is being taken to court. An expensive cancer drug, Lupron, has been allegedly administered through free samples by the doctors, and then billed to their patients' insurance companies. Pretty soon, the idea had made it's way to the drug company's employees and doctors in over seven different states, making an almost uncontrollable problem.
The drug, which was originally offered by the producer to doctors for free, was administered in the hopes that the doctors would create a popularity in the drug, but also so they could sell their free doses as a way to pay off their debt to that company with the money they obtained. Now, these samples that run about $566 for a monthly dose, are finding their way into doctors hands. The only serious charges filed so far are against Dr. Rodney Mannion, a urologist from Indiana, who allegedly profited between $40,000and $70,000 for 60 one-month doses billed to the insurers.
