CONFIDENTIALITY AND HEALTH-INSURANCE FRAUD

Background: Health insurance fraud committed by patients may be an inc reasing problem given the number of underinsured and uninsured people in the United States. Physicians recognizing acts of health insurance fraud perpetrated by patients face an ethical dilemma: should they dis close the incident to the insurance company, or protect patient confid entiality? Objective: To explore physicians' attitudes toward the repo rting of patient-initiated health insurance fraud. Methods: Three hund red seven physician members of the American College of Physicians retu rned a mailed questionnaire that presented 6 case vignettes (3 variabl es) of patients who used a relative's insurance to obtain health care in the past. For each vignette, respondents were asked whether the tre ating physician should report insurance fraud to the health insurance carrier. Results: Sixty-three respondents (20.7%) indicated that physi cians should report all the patients presented in the vignettes, while 45 (14.8%) indicated none should be reported; the rest indicated that the decisions to report should be based on the characteristics presen ted, with acute vs terminal illness (P<.001), history of fraud (P<.001 ), and wealth of the patient (P<.001) all causing physicians to be mor e likely to report the patient to the health insurance carrier. Multiv ariate analysis demonstrated that type of practice (P=.04) and respond ents' experiences with insurance fraud (P=.03) had significant effects on the willingness to report patients. Conclusions: Physicians are di vided about whether to report patients who have committed insurance fr aud. Their decisions to report insurance fraud are influenced by their attitudes and demographic features, as well as by patient factors.