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MDs working for insurance companies. Thoughts?


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Given that the insurance company ultimately pays the doctors for their opinions, reports & testimony, that the name of the game for the insurance company is to limit the pay out, that the name of the game for the doctor is to obtain repeat business from the insurance company, it is sad that some doctors are willing to sell their professional and ethical souls for the dollar by advocating for the insurance company indirectly by not being truthful and objective in their opinions. Repeat business won't be theirs if doctors regularly confirm the patients' complaints are justified. On the other side of the coin, there are doctors who help patients exaggerate their conditions so as to increase the amount of future settlements or litigation judgments. The love of money is the root of all evil! :(

 

 

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Yeah that was pretty disheartening to read... Especially the end where it seems like the CPSO doesn't do much about it.


This is just a thought off the top of my head, but imagine if there was 1) a government regulated group/branch that looked after these doctors working with insurance companies, and 2) mandate that all insurance companies legally have to seek opinions/assessments from doctors of this group/branch - it may eliminate the pressure for doctors to lie and for insurance companies to deny claims for those who need the insurance. It may also eliminate the "independent deals" that unethical doctors make with insurance companies to remain employed.

Or even have something like a jury duty, but specifically for doctors and insurance companies - the doctors are chosen by random and remain anonymous in their assessment. And regardless of the final conclusions/opinion given made, insurance companies have to pay the same fixed fee to the physicians for their services.

Just random ideas - whether they are any good is definitely debatable.

But one thing is that it all sounds way too close to what happens in the US with health insurance and denial of coverage for treatments... If this happens in Canada with auto insurance, who's to say that this wouln't happen if we were to introduce a 2-tier system with private health insurance?

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The last part about the CPSO not doing much is definitely discouraging. It seems like insurance companies have the money to buy the time and assessment of certain clinicians, but the patient's own primary care providers may lack the time/resources to be able to advocate appropriately for their patients due to high patient volume, etc. I don't know if we can perhaps incorporate administrative time spent preparing cases for patients into current billing practices, seems unlikely :/

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Looks like Ontario government will be moving to rein this.  Not only unethical doctors provide skewed opinions, but also private, for-profit assessment companies alter medical reports to suit insurance companies. Globe's investigation revealed that some of the medical reports were ghost-written. 

On the other side, we have fake insurance claims also supported by medical reports, this time enticed by lawsuit lawyers.

At the end, the beneficiaries are insurance companies, unethical doctors, crooks and lawyers. The losing parties are true victims of accidents, and the public who have to pay for fake claims.

While the interest of insurance companies is what it is, the stance of CPSO is inexcusable. They don't sanction these doctors even if it is proven in court that medical report was seriously biased, or full of errors or omissions, or contradicting the facts. CPSO  should  guard high standards of profession, not  protect bad practices and bad doctors.  This doesn't seem to be the case.

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  • 4 weeks later...
On 12/4/2017 at 7:46 PM, osteoarthritis said:

who cares. make that money, drown in cash and women. swag swag

well not exactly tastefully stated by a long shot there is a very good reason to care, and actually it is one of those times when it doesn't matter if you are for maximizing your income or maximizing benefit to you patients (to take a polar opposite approach).

It is extremely short sighted because shockingly relatively quickly it gets noticed and then it is in the papers etc. Now the college is going to investigate because they have little choice and if you are that doctor you better hope they don't find anything in any way biased. If they do then good luck because you are going to need it. Once you are even investigated then you are going to have a hard time being an expert witness as the other side has a great and permanent way to attack you and make you useless. You won't have many friends after that. You won't be welcomed back with open arms anywhere either as you are both out of practice for awhile and again have been investigated. Now what? You just killed the golden goose.

The college is repeatedly in the news with regards to not chasing after doctors doing questionable things - if for no other reason than to protect itself it is becoming more aggressive. They don't like bad publicity. 

The one way to eventually get squashed in medicine is being too greedy. 

and then there really is that little thing about actually helping your patients ha. 

Edited by rmorelan
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