Lying for Patients

Abstract

IN THE past decade, managed care programs have increased their role in the daily practice of medicine.¹ Physicians have experienced pressure from managed care organizations (MCOs) to reduce utilization and curtail costs. Practice controls such as utilization restraints and preapproval criteria have limited physician autonomy.^2-5 As MCOs impose stricter controls on access to specific medical treatments, physicians are increasingly facing an ethical dilemma—how to reconcile their professional responsibilities as patient advocates with potentially conflicting contractual obligations to third-party payers. Anecdotal evidence^6-9 suggests that some physicians have chosen to maintain the appearance of compliance while skirting managed care guidelines in order to secure treatment. Such deception, primarily in the form of incorrect or ambiguous documentation, has been called "gaming the system."¹⁰ However, the full extent to which physicians support the deception of third-party payers, particularly for which clinical indications, remains unknown. Furthermore, physicians' attitudes and beliefs about the use of deception are not well characterized. We report the results of a study investigating physicians' attitudes toward the deception of third-party payers, and identify clinical and demographic patterns associated with the sanctioning of deception.