How Some Patients Fake Illness or Injury and Get Away With It

Leigh Page


May 14, 2019

In This Article

Patients May Lie to Their Doctors

Some patients lie to their doctors. In a 2018 survey of patients, 47% admitted that they often or sometimes lie to their doctors, and another 30% said they also lied, but only rarely. That left just 23% who claimed that they never told their doctor a lie.[3]

Most of these lies are not related to injury claims. The same survey found that patients most often lie about how closely they adhere to doctors' orders (39%), how much they diet or exercise (37%), or how they conduct their sex life (32%). However, the survey also found that almost 20% lied about how they were injured, where the goal often is to get on disability.

One expert surmised that many patients exaggerate their injury because they think that otherwise, they wouldn't be believed. "Some patients, especially those concerned that their symptoms are not being taken seriously, will invent symptoms or exaggerate the severity of those already present," he stated.[4]

When patients lie about their symptoms for no apparent benefit, it could be a mental health condition called "factitious disorder." More often, however, they lie for some form of financial or material gain, which is known as "malingering."

For centuries, malingering meant avoiding military service. During the Vietnam War, it was common for young men to bring up a medical or psychiatric condition to get out of the draft. Although the US military draft has ended, many other kinds of malingering flourish.

Why Patients Fake Illness

Much malingering can be relatively trivial, such as patients who ask for a doctor's note to avoid jury duty, even though they're not sick. Other deceptions involve higher stakes, such as faking a slip and fall on someone's property and then suing to collect medical benefits.

Some fakers have been dramatically caught out. In 2013, a man slipped and fell on the property of the Washington, DC, Metropolitan Area Transit Authority and sued for $15,000. But his ruse was caught on a surveillance video camera.[5]

In another incident just this year, a routine surveillance video caught a New Jersey man staging a slip and fall to collect workers' comp. The video went viral on the Internet. It showed him dumping a cup of ice onto the floor, placing himself on the floor, and waiting to be discovered.[6]

Two big attractions for malingerers are the Social Security disability program, run by the federal government, and workers' compensation insurance, funded by employers.

Together, these two programs spend $260 billion a year, mostly in payouts,[7] and involve a huge number of people. In 2010, fully 18% of all Americans claimed to have some form of disability, and the majority of those disabilities were listed as severe, according to the US Census Bureau.[8]

Faking illness or injury can also affect private disability insurance, comprising group policies offered by employers and private policies bought by individuals. These smaller programs tend to be more closely monitored than the two bigger categories, but they also are plagued with sham illnesses.

Many people who seek payments from these programs have real disabilities, but others engage in some kind of faking, Dorto says. "When a certain amount of people are 50% hurt, they say they're 75% hurt in order to get better recovery, better benefits, and the like," he says.

People often simply feel entitled to payments, says Gary W. Pushkin, MD, an orthopedic surgeon in Baltimore who reviews claims for insurers. "You get people who worked their whole career and they now have pain, so they feel entitled to have it covered, even if it's not appropriate," he says.

Fakers "can be your average person just thinking that it's an easy way for them to make some money," a Florida claims investigator told ABC News. "Do they realize what kind of a crime they're committing? I don't think they think about it."[9]


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