Case and Commentary
Apr 2000

Intentional Misdiagnosis to Get Insurance Coverage

Faith Lagay, PhD
Virtual Mentor. 2000;2(4): doi: 10.1001/virtualmentor.2000.2.4.hlaw1-0004.

Case

A 32-year-old man presents with no significant past medical history. The patient's 38-year-old brother was recently diagnosed with colon cancer and recently underwent a subtotal colectomy. Given the young age of his brother, the patient is now concerned about getting (or already having) colon cancer. Although he has no abdominal symptoms, he insists on a screening colonoscopy. The physician shares the patient's concern and believes that given his family history such an intervention is warrented. However, the patient's health insurance plan will not pay for a colonscopy, but the physician knows that the plan will pay if the patient has had recent weight loss and change in bowel habits, although this diagnosis is inaccurate.

Question for Discussion

What should the physician do? [1-7]

See what the AMA Code of Medical Ethics says about this topic in:

Opinion 8.12 Patient information. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:263-265.

Opinion 8.13 Managed care. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:266-274.

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Citation

Virtual Mentor. 2000;2(4):

DOI

10.1001/virtualmentor.2000.2.4.hlaw1-0004.

The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.