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

Leigh Page

Disclosures

May 14, 2019

In This Article

Is It Worth Risking a Bad Patient Review?

Even when physicians have some evidence that a patient is faking, Pushkin says they may not want to challenge the patient because it could lead to a bad review. Pushkin himself has gotten some scorching online reviews for having to say no to patients as a review physician.

"Quite possibly the meanest doctor I have ever been to," reads a review of him on Vitals. "He is rude and arrogant and acts as if he knows everything."[13]

The anger in these reviews is palpable. A patient who said Pushkin turned down his long-term disability claim stated, "This has firmly created a financial hardship on my family. Thanks."[14]

Pushkin admits these reviews still sting, but he has learned to develop a thick skin as a review physician. He thinks they would affect treating physicians more deeply, because they have an emotional bond with long-term patients and could lose them. He adds that some institutions rate their employees on the basis of patient satisfaction scores.

When Doctors Historically Helped Patients Lie

In some cases in the past, doctors actually collaborated with malingerers. During the Vietnam War, doctors wrote letters citing minor conditions to get young men out of the draft. President Trump, for example, got out of Vietnam service with a podiatrist's note citing bone spurs in his heels. (Today, some physicians say bone spurs were not a legitimate reason to avoid service, but others say they can be quite painful in some cases.)[15]

In the Vietnam era, many doctors believed playing up minor conditions was justified because the goals of the war were questionable. Today, many doctors are willing to help patients skirt insurance coverage rules for similar reasons.

Helping Patients Get Goodies

Aren't these fairly minor issues? Not for David Mokotoff, MD, a semi-retired cardiologist in St Petersburg, Florida, who does some reviews for insurers.

"I won't lie for patients," he says. Furthermore, a note on jury duty would usually be a very transparent lie for him. "It's very rare that someone could be legitimately disqualified from jury duty for cardiac problems," he says.

Doctors' authorization of handicap license plates for faking patients is an "awful area of abuse," Mokotoff adds. In California, for example, 1 in 8 drivers had a handicap plate or temporary placard in 2016, according to a news report.[16]

In the same vein, Medicare requires a face-to-face doctor's examination for beneficiaries to get motorized wheelchairs, known as "power mobility devices," which cost $650-$3500 each.

In the early 2000s, federal authorities launched Operation Wheeler Dealer, which recovered $84 million in fraudulent claims for power mobility devices—in many cases due to graft by retailers. Medicare spending for these devices had "skyrocketed" to more than $1.2 billion a year, the Centers for Medicare & Medicaid Services reported at the time.[17]

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