Many Doctors Stretch the Truth for Their Patients
For some physicians, the temptation to upcode or otherwise squeeze more money out of health insurers is irresistible.
In May 2013, the Departments of Justice and Health and Human Services announced that 89 medical professionals had been charged with fraudulently billing Medicare for more than $223 million, and that's just one of many such cases.
Few people would defend physicians who upcode, charge for services that they haven't provided, or falsify medical records to boost their earnings. But what about doctors who code "creatively," or submit misleading paperwork on the patient's behalf?
One survey of 740 practicing physicians found that a whopping 39% manipulated reimbursement rules -- including exaggerating the severity of patients' conditions, changing patients' billing diagnoses, or reporting signs or symptoms that patients did not have -- to help the patients secure coverage for needed care.
Can these doctors, acting as patient advocates, get into as much trouble -- and are they acting as unethically -- as physicians whose primary motivation is to line their own pockets?
Moral Ambiguities? Depends on Whom You Ask
For many doctors, a lie is a lie, no matter how altruistic the motivation. Leslie N. Trubow, MD, a pediatrician in Addison, Illinois, says that he refuses to comply when uninsured patients ask him to write prescriptions in the name of a family member who has coverage. He also turns down requests to enter a sick-visit code when patients do not have well-visit coverage.
Similarly, Patricia Roy, DO, a family physician in Muskegon, Michigan, says that she won't lie, exaggerate, or fabricate information, whether the patient wants an excuse for absence from work or school, a justification (and thus a refund) for a missed flight, or paperwork indicating that a cosmetic plastic surgery procedure was medically called for.
Not all "fudging" requests are related to medical treatment. Some concern time. Sumana Reddy, MD, a family physician in Salinas, California, recently saw a stressed-out mother who had taken her full disability and Family Medical Leave Act time off, but wanted Reddy to buy her a few more weeks off while she arranged for child care. "It was really hard, but I just couldn't do it," says Reddy.
William Mullis, MD, a pediatric plastic surgeon in Charlotte, North Carolina, settles requests for purposeful miscoding by replying, "I don't think you want a liar or a cheat for a doctor."
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Cite this: Would You Lie to Help a Patient in Need? - Medscape - Jul 01, 2013.