Cain J M
Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle.
Obstet Gynecol. 1993 Sep;82(3):475-8.
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.
向保险公司虚假报告手术适应症以获取未涵盖服务的报销，给从业者带来了伦理和法律问题。虚假报告的动机源于这样一种期望，即医生推荐的任何医疗干预——即使益处不大——都应得到覆盖。这种传统期望与不断变化的医疗经济状况相冲突。患者对医疗技术和保险的期望也助长了欺骗行为。进行欺骗的医生没有认识到医疗经济模式的变化，危及自己未来的行医，也没有为住院医生和学生树立技术和道德典范。这种欺骗行为排除了与保险公司进行任何可能对话的可能性，而这种对话可能会为更多患者争取到保险覆盖。无论对患者还是医生来说，虚假报告当前和未来的有害后果都远远超过任何暂时的金钱收益。
