Topic: Fraud and Abuse
Eleanor Stevens is a health insurance professional for a medical clinic. Clara Bartlett, a patient of the clinic, comes in for a physical examination. After the examination, Mrs. Bartlett approaches Eleanor and says, “Hon, my insurance company doesn’t pay for doctors’ visits unless I am sick or something. Dr. Forrest says I’m perfectly healthy, so I’ll have to pay today’s charge out of my own pocket. I’m a little short on money this month – the high cost of utilities and all – you understand don’t you? I’m wondering if you could help me out just a little by fudging something on the claim so my insurance will pay for it.”
How might Eleanor handle this situation?