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The Fluffiest Fraud

, , , , , | Healthy | February 16, 2022

I work as a vet. Our computer system is set up so that we can submit our clients’ insurance claims for their visits directly to their insurer — just a few clicks to submit the notes and the invoice, minimal hassle for everyone. We don’t have any way of knowing whether or not the claim gets accepted or rejected unless the client lets us know.

Client: “The claim for Fluffy’s [condition] got rejected.”

Me: “Ah, that’s a bugger. We had discussed that it might not get through because it would probably be considered pre-existing, but at least we gave it a go and know for the future.”

Client: “Yeah, sure, but what did you write in the submission claim? Like, the wording?”

Me: “I just submitted my clinical record. There aren’t any notes we write in addition to that.”

Client: “But what did you say Fluffy had?”

Me: “[Condition]. Which is what he has.”

Client: “Do you think you could resubmit it but write that he has [similar condition, which has similar symptoms but is treated differently]?”

Me: “Uh, no.”

Client: “Why not? It’s easy; just change a couple of words and it’s all good. Then it might get approved.

Me: “[Client], I will explain this very clearly to you. The clinic system locks the records after a certain time frame because they are classed as legal documents. Any changes to said documents after the fact would be grounds for me to face disciplinary action from my professional regulator. And very simply, what you are asking me to do is commit insurance fraud.”

Client: “Are you sure about that?”

Me: “Uh, yes, definitely fraud.”

Client: “So, you can’t do anything to get around it?”

Me: “No. I like my job. I’m not risking my licence.”

Client: “So, there’s really nothing you can do about this, then.”

Me: “[Client], stop asking. The answer is no. If you still don’t like it, you’re welcome to see one of my colleagues, but they will tell you the same thing, and your insurer already has the info anyway.”

Client: “…”

He wasn’t a client of ours for much longer. I can’t say he’ll be missed. Good luck and apologies to the next clinic who ended up with him.

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