Is deception for reimbursement in obstetrics and gynecology justified?
Deceptive reporting to insurers of procedure indications to obtain reimbursement for non-covered services creates ethical and legal problems for practitioners. The motive for deceptive reporting is rooted in the expectation that any medical intervention recommended by the physician--even if of marginal benefit--should be covered. This traditional expectation collides with changing medical economics. Patient expectations of medical technology and insurance also promote deception. The deceptive physician fails to acknowledge a changed paradigm of medical economics, threatens his or her future practice, and does not model technical and ethical virtues to residents and students. Such deception preempts any possible dialogue with insurers that might result in coverage for a larger group of patients. The harmful outcomes of false reporting, present and future, far outweigh any temporary monetary gain for the patient or physician.
Cain
J M
JM
Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle.
D008192:Deception; D006176:Gynecology; D007349:Insurance, Health, Reimbursement; D009774:Obstetrics