Case 2 – MEDICAL INSURANCE FRAUD BY “INTERNATIONALLY RENOWNED” SLEEP SURGEON

 

A Caucasian patient (Mr F K) was found to have obstructive sleep apnea (OSA) and surgery was recommended by the same sleep surgeon (as in case 1). An excerpt of the patient’s email correspondence with this sleep surgeon is shown below. The first email (Figure 1) lists the surgeries recommended by the doctor. From the list, pharyngoplasty and tongue suspension are done only for obstructive sleep apnea in an ENT setting. The email also highlights how prohibitive the cost of the procedures. SGD19000 to SGD27000 is significant higher than what most reasonable ENT sleep surgeons would charge for the procedures listed. The second part of the email (Figure 2) clearly shows the sleep surgeon instructing the patient to provide false and misleading medical information to his medical insurers by intentionally avoiding the term ‘sleep apnea’ and instead use diagnoses such as sinusitis, tonsillitis etc.

Takeaway Point

From the list of recommended surgeries, we can conclude that Mr K has OSA. It is true that certain medical insurers exclude sleep apnea and sleep related disorders from the list of procedures that are covered by insurance. Nonetheless, what the email correspondence shows is tantamount to medical insurance fraud, a charge that can result in the doctor’s medical license being suspended and the patient charged with a criminal offence. Patients should always be careful to provide their medical insurers with accurate information on their medical conditions, even if the doctor is willing to distort the true nature of their medical condition.

Dr Gerard Chee

MBBS (S'pore), FRCS (Edin), FRCS (Glasg) Fellow, Otology / Neurotology (Can)

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