Lying to Insurance Companies: The Desire to Deceive among Physicians and the Public

University of Pennsylvania, USA.
The American Journal of Bioethics (Impact Factor: 5.29). 02/2004; 4(4):53-9. DOI: 10.1080/15265160490518566
Source: PubMed


This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26%versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22%versus 59%). The odds of public support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources.

Download full-text


Available from: George Caleb Alexander
  • Source
    • "For example, studies in the USA showed that from 10% to about 40% of physicians reported manipulating reimbursement rules or their willingness to manipulate such rules to enable patients to receive the care that the physicians perceived as necessary [32]–[35]. More importantly, a large survey of prospective jurors and physicians in the USA showed that the public was more than twice as likely as physicians to allow deception that might benefit patients (26% versus 11%) [37],[38]. Further, it seems public support for deception (as compared to physicians) may have increased over time [36],[37]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the importance of health care fraud and the political, legislative and administrative attentions paid to it, combating fraud remains a challenge to the health systems. We aimed to identify, categorize and assess the effectiveness of the interventions to combat health care fraud and abuse. The interventions to combat health care fraud can be categorized as the interventions for 'prevention' and 'detection' of fraud, and 'response' to fraud. We conducted sensitive search strategies on Embase, CINAHL, and PsycINFO from 1975 to 2008, and Medline from 1975-2010, and on relevant professional and organizational websites. Articles assessing the effectiveness of any intervention to combat health care fraud were eligible for inclusion in our review. We considered including the interventional studies with or without a concurrent control group. Two authors assessed the studies for inclusion, and appraised the quality of the included studies. As a limited number of studies were found, we analyzed the data using narrative synthesis. The searches retrieved 2229 titles, of which 221 full-text studies were assessed. We found no studies using an RCT design. Only four original articles (from the US and Taiwan) were included: two studies within the detection category, one in the response category, one under the detection and response categories, and no studies under the prevention category. The findings suggest that data-mining may improve fraud detection, and legal interventions as well as investment in anti-fraud activities may reduce fraud. Our analysis shows a lack of evidence of effect of the interventions to combat health care fraud. Further studies using robust research methodologies are required in all aspects of dealing with health care fraud and abuse, assessing the effectiveness and cost-effectiveness of methods to prevent, detect, and respond to fraud in health care.
    Full-text · Article · Aug 2012 · PLoS ONE
  • Source

    Preview · Article ·

  • No preview · Article · Feb 2004 · The American Journal of Bioethics
Show more