Ethics Consult: Let Look-Alike Sisters Commit Well-Intentioned Insurance Fraud?

Ethics Consult: Let Look-Alike Sisters Commit Well-Intentioned Insurance Fraud?

August 5, 2022 0 By Jennifer Walker

Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

A middle-age woman, Vivien, appears for her first appointment with an oncologist, Rocky Bock, MD, to begin treatment for a rare form of cancer. She is accompanied by her sister, Jeanne, to whom she bears a striking resemblance. On evaluation, the physician notes several major inconsistencies between the patient’s medical records and the findings from her physical exam. Most notably, previous doctors have documented that the patient lost her left index finger in an automobile accident, but Vivien appears to have all 10 of her digits intact.

Bock confronts Vivien about these inconsistencies, and she confesses that she is actually Jeanne and that the two sisters have conspired to exchange identities because Jeanne has health insurance while Vivien is an undocumented resident of the U.S. and has no way of obtaining insurance or paying for cancer treatments. The chemotherapy required to treat her cancer costs over $150,000, and the sisters cannot realistically raise that amount of money quickly. Vivien and Jeanne both plead with the doctor to “overlook” his discovery. Bock sincerely believes that the treatments will save the woman’s life.

Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

Check out some of our past Ethics Consult cases:

Wrong to Offer Cheap, Pirated Version of Drug?

Cut Health Insurance for Risky Activities?

Stop Life Support for a Tax Break?