Believe it or not: Widely-held viewpoints enable fraud


Lately I've wondered how much the battle against health insurance fraud, waste and abuse is hampered by beliefs that thwart the cause. Beliefs drive behavior. And certain longstanding beliefs about insurance companies, healthcare providers and fraud work against recognition and reporting of this crime. While recent news gives heartening examples of Senior Medicare Patrols volunteering to fight fraud, ingrained beliefs may prevent others from getting similarly indignant about it.            

Commercial payers trying to enlist public support for anti-fraud work may run into a brick wall: Surveys have consistently shown customers dislike insurance companies and don't want to engage with them, according to the technology and management consulting firm Perficient.

Compounding this problem is the mistaken notion that health insurance fraud is a victimless crime. Some people think insurers are swimming in money since they're quick to collect premiums (which keep going up) but slow to pay claims.

Lines from the 1966 movie "The Fortune Cookie" express this belief. "Insurance companies have got so much money they don't know what to do with it," said Walter Matthau as seedy lawyer Whiplash Willie Gingrich. "They've run out of storage space for it. They have to microfilm it!"

Some people have no qualms about stealing from insurers since they don't consider them sympathetic fraud victims. Others are so hostile toward payers they think financial loss is their just due. Customers often don't understand how fraud thins out their own wallets.    

One payer launched a fraud awareness campaign to drive home this point. The message was this: "Fraud costs employers, costs insurers and costs you. It adds $200 a year to the cost of an individual premium and $400 to the cost of a family premium. What would you do with the extra cash?"

Assumptions about who commits fraud also can be harmful. It's easy for people to believe health insurance fraud is committed by organized criminals or fly-by-night medical equipment suppliers working out of gas stations; but it can be hard to accept that a small subset of the people we trust to deliver our babies, drive cancer into remission or hold a beating human heart in their hands can turn around and file a boatload of false claims. Yet sometimes they do, and so do hospitals.  

Moreover, some people think medical professionals--with their long years of education--are too smart to commit fraud. But fraud, waste and abuse have reared their heads in all disciplines of medicine no matter how prestigious or advanced. A cardiologist practicing in New York and New Jersey, for example, last year committed what the government called the biggest health insurance fraud in the history of law enforcement activity in those two states.

Fraud fighting can be hampered by the odd but prevalent self-justification that doing good in some areas atones for wrongdoing elsewhere. It's as if there's a giant cosmic ledger up in the sky. As long as our contributions to life outweigh the damages we do, then what's the harm in a little fraud? Ethicist Marianne M. Jennings, J.D., calls this belief a surefire predictor of corporate demise in her book "The Seven Signs of Ethical Collapse."

If belief creates reality, then repudiating false beliefs about fraud may be an important step towards controlling it, especially when those beliefs are stubborn and pervasive. - Jane (@HealthPayer)

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