Insurance Ethical Dilemmas
The ethical dilemma proposed in this case study involves a psychologist who purposefully miscodes a client’s clinical diagnosis while billing the insurance for services since half of the patient’s clinical diagnosis is often declined for payment by the insurance company. While the therapist was only trying to help the patient out by saving them money by getting the insurance company to pay for all the services provided, the psychologist was unethical in not disclosing all the appropriate information to the insurance company. In fact, not disclosing this information could be perceived as insurance fraud and the company could pursue legal action if they found out that the therapist had purposefully withheld this information (Koocher & Keith-Spiegel,
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2016). By withholding this client’s clinical diagnosis from the insurance company, not only is the practitioner committing insurance fraud but they are violating the APA’s (2010) guidelines for recording and filing fees for services.
For instance, Standard 6.06 recommends that psychologists every reasonable step to provide accurate reports on which services are provided to the client, the type of research conducted (if any), any charges or payments the client, and information about the provider. The same Standard further suggests that any findings, along with the formal diagnosis given to the patient, also be accurately reported to any payors that provide funding or compensation for the services, including therapy (APA, 2010). In order to prevent this ethical dilemma in the future, the therapist should properly document all of the information appropriately and report all of the findings on a patient to the insurance company in order to let them decide if the services are covered or not. It’s far better to accurately report this information and then appeal the decision if services are denied than to possibly go to jail for committing insurance fraud. Aside from being just a criminal defense, however, the offense in this case study may also damage the practitioner’s professional reputation within the field of psychology and it will likely cost him his license as
well.
2016). By withholding this client’s clinical diagnosis from the insurance company, not only is the practitioner committing insurance fraud but they are violating the APA’s (2010) guidelines for recording and filing fees for services.
For instance, Standard 6.06 recommends that psychologists every reasonable step to provide accurate reports on which services are provided to the client, the type of research conducted (if any), any charges or payments the client, and information about the provider. The same Standard further suggests that any findings, along with the formal diagnosis given to the patient, also be accurately reported to any payors that provide funding or compensation for the services, including therapy (APA, 2010). In order to prevent this ethical dilemma in the future, the therapist should properly document all of the information appropriately and report all of the findings on a patient to the insurance company in order to let them decide if the services are covered or not. It’s far better to accurately report this information and then appeal the decision if services are denied than to possibly go to jail for committing insurance fraud. Aside from being just a criminal defense, however, the offense in this case study may also damage the practitioner’s professional reputation within the field of psychology and it will likely cost him his license as
well.