1997
DOI: 10.1001/archinte.1997.00440260035007
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Confidentiality and Health Insurance Fraud

Abstract: Physicians are divided about whether to report patients who have committed insurance fraud. Their decisions to report insurance fraud are influenced by their attitudes and demographic features, as well as by patient factors.

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Cited by 6 publications
(4 citation statements)
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“…Resistance to such practices may also explain physicians' unwillingness to cooperate with third-party payers in other areas, including disclosure of patient information 22 and suspected patient health insurance fraud. 23 Both MCOs and professional societies are aware of this trend in physician behavior. 10,[23][24][25][26][27] Managed care firms have responded to inaccurate claims by increasing the rigor of utilization review and terminating contracts with physicians suspected of using deception.…”
Section: Commentmentioning
confidence: 99%
See 1 more Smart Citation
“…Resistance to such practices may also explain physicians' unwillingness to cooperate with third-party payers in other areas, including disclosure of patient information 22 and suspected patient health insurance fraud. 23 Both MCOs and professional societies are aware of this trend in physician behavior. 10,[23][24][25][26][27] Managed care firms have responded to inaccurate claims by increasing the rigor of utilization review and terminating contracts with physicians suspected of using deception.…”
Section: Commentmentioning
confidence: 99%
“…23 Both MCOs and professional societies are aware of this trend in physician behavior. 10,[23][24][25][26][27] Managed care firms have responded to inaccurate claims by increasing the rigor of utilization review and terminating contracts with physicians suspected of using deception. Professional societies have standing guidelines that prohibit fraudulent misrepresentation in dealings with insurers.…”
Section: Commentmentioning
confidence: 99%
“…They argued that while in the extreme, alternate coding may involve deception and potential fraud that calls professional ethics into question, many physicians believe that they are advocating for patients or adopting coding mechanisms that are encouraged in the present system. Previous studies on adult patient providers have identified similar alternate coding practices for a variety of conditions, including mental health problems 7–11 …”
mentioning
confidence: 99%
“…Lying to patients about their diagnoses was ubiquitous in the United States until only a few decades ago, 3,4 and is still common in many other countries. [5][6][7][8] Physicians commonly use deception to resolve ethical dilemmas, 9 particularly when dealing with insurance companies [10][11][12] and when attempting to act in their patient's interests. 9 Some physicians even participate in outright fraud.…”
mentioning
confidence: 99%