Doctors Admit Falsifying Insurance Claims com

April 12, 2000

A recent study suggests that doctors manipulating reimbursement rules so that their patients can receive the care they need is on the rise as doctors feel more pressure to provide treatment not authorized under managed-care plans.

More than one of every three doctors interviewed in the study admitted to deceiving insurance companies to help patients get necessary care according to the 1998 mail survey reported in the most recent Journal of the American Medical Association.

The doctors admitted using tactics including exaggeration of the severity of a patient’s illness, listing inaccurate diagnoses on bills and reporting nonexistent symptoms in an effort to secure insurance coverage.

Of the 720 doctors surveyed, 39 percent said they had used at least one of the tactics within the preceding year. And 37 percent said their patients had “sometimes” or more often asked them to deceive insurers. And more than 25 percent of the doctors said they believed it is necessary to manipulate reimbursement rules in order to provide high-quality care. And of those doctors reporting such manipulations, 54 percent said they did so more often than in the past.

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