Doctors Take on New Role: Robin Hood

  • Share
  • Read Later
A very unlikely white knight is galloping over the hill to rescue the American public from the grips of penny-pinching health maintenance organizations: Just call him Dr. Deception. As more people depend on managed care programs for their routine medical care, doctors are increasingly bucking the HMO guidelines in order to give their patients the treatment they need. According to an article published Wednesday in the Journal of the American Medical Association, 39 percent of doctors surveyed in 1998 admitted to having deceived insurance companies at least once. And 54 percent of those physicians reported their rate of deception had gone up in recent years. The prevaricating doctors used a variety of tactics: exaggerating the severity of patients' conditions, reporting nonexistent symptoms and listing inaccurate diagnoses on bills.

The doctors who bend the insurance companies' rules, according to the JAMA report, do it because they disagree with an HMO policy or restriction on care. "It's not difficult to be sympathetic to that impulse," says TIME medical writer Christine Gorman. "Often, doctors are faced with a judgment call: If a patient is going to be sent home to an empty house, with no one to take care of them, a physician may very well feel justified keeping the patient for one more night." And in fact, says Gorman, even doctors who admit to thumbing their noses at HMO guidelines may not be committing fraud in the strictest sense of the word. "There may be situations in which if a doctor or patient appealed an HMO's decision, the patient would be able to stay longer." The problem the doctors face, of course, is one of immediacy: The patients who most need special consideration are often those who can't wait for the result of a lengthy review process.