As pet insurance becomes more common, veterinary hospitals are increasingly being asked to alter medical records in order to make sure the bills will be paid by the insurance company. Usually, it is the pet owner who is asking to have the medical record altered to avoid having a problem considered a pre-existing condition or to change the record or charges so that they will fall under a covered category. Other times, it is soft-hearted doctors or staff members who want to alter the record to increase the insurance payments for the owner or hospital. Generally the person making the request justifies it by thinking “it doesn’t harm anyone.” Unfortunately nothing could be farther from the truth and altering medical records for insurance purposes can be damaging to the pet, the owner, the hospital, and the pet owning public.
Veterinarians rely on complete, accurate medical records to help diagnose and treat patients. If a diagnosis or treatment is left out of the medical record or misreported, the pet may not be properly diagnosed or treated in the future. Just as importantly, when people deceive an insurance company in order to collect money to which they are not entitled, it is considered insurance fraud. Insurance fraud is a crime in all 50 states and health care insurance fraud is a federal crime. Depending on the circumstances, insurance fraud may be a misdemeanor or a felony and can result in monetary fines, community service, or imprisonment. Everyone who knowingly participates in the fraud is considered at fault, not just the individual who benefits monetarily. Doctors and technicians who participate in insurance fraud are violating their codes of ethics and can face the loss of their professional licenses in additional to criminal prosecution. The cost of insurance fraud is ultimately borne by policyholders and consumers because the insurance companies are forced to charge everyone higher premiums to cover fraud losses.
Practice managers should make sure their hospitals have clear medical record policies that require all histories, diagnoses, and treatments to be included in the medical record at the time the patient is seen. Medical records should only be altered if there is a legitimate mistake in the record and never for the purpose of increasing insurance payments. If it is necessary to correct a legitimate mistake, notes explaining the reason for the correction should also be included. Staff members and doctors should be educated on the dangers of insurance fraud and how to respond if a client asks for their records to be altered for insurance purposes. If insurance fraud is discovered after the fact, it should be reported to the insurance company. These steps will help protect the hospital and its employees from being charged with insurance fraud.