The Question Is, Who is Defrauding Whom?

CBC National News anchor Peter Mansbridge was filled with the appropriate level of indignation introducing the story of insurance fraud on the April 16, 2010 edition of the National. Unfortunately, the CBC’s pro alternative-medicine bias (examples of which are searchable on this site) placed the CBC in a position where they couldn’t quite get it straight as to who is defrauding whom.

The “investigative journalistic report” came complete with hidden cameras, disguised microphones and undercover journalists posing as customers. In reality, what we got was a public relations exercise posing as journalism.

Here is the story. The CBC ‘uncovered’ that beauty-spas are billing health insurance companies for a virtual cornucopia of complementary and alternative medicine  services such as acupuncture, message therapy, osteopathy, naturopathy and chiropractic where where in fact, the beauty spas were only providing cosmetic services. For example, a beauty spa provides hot rock ‘therapy’, and claims it as message therapy. The hot rocks treatment is listed on an bill as massage therapy, signed by a  registered massage therapist, and then submitted to the insurer for payment. It was reported that one spa representative offered to cover $2,000 worth of cosmetic services with fake receipts.

Alistair Forsythe, a senior researcher and spokesperson at the Canadian Health Care Anti-Fraud Association, that represents the health insurance industry, was quoted in the CBC report as saying: “We call that theft at the end of the day.”

Well, the Canadian Health Care Anti-Fraud Association should know.

It wasn’t all that long ago that the health insurance industry refused to pay for alternative medical treatments and therapies on the quite sensible grounds that there was no evidence that such treatments were in any way effective. Insurance companies didn’t want to pay for therapies that didn’t work.

That attitude changed when the bean counters (primarily in health care insurance companies in the United States) pointed out that whether the treatments worked or not was irrelevant. All that mattered was the comparative cost of an alternative medical practitioner to a real doctor and the subsequent impact on corporate profits. By covering alternative treatments, insurance companies could save themselves a fortune. So what if the treatment is cosmetic or bogus? Better to pay $250 for worthless treatments (that could see the patient become seriously ill or worse) than pay $4,000 (for a treatment that may actually do some good).

The beauty of this real insurance scam is that it can be promoted as providing freedom of choice. Mrs. Smith, you can go through a long and painful chemotherapy treatment in which you will loose your hair and suffer terribly or you can stretch out here in our therapy spa and have someone gently massage your back with parsley, sage, rosemary and thyme. It’s a false choice of course – no one ever says: You can live or you can die. Turns out, honesty is bad for profits.

Insurance coverage of alternative medical practices was a cynical attempt by health insurance companies to reduce costs by replacing costly but effective treatments with cheaper ineffective treatments – the patient be damned – literally.

Of course, the insurance industry was warned of this slippery slope. Once you start funding scientifically useless treatments, there will be no end to it. Pretty soon, you will be funding everything. That is exactly what is happening now. You reap what you sow.

For example, benefit plans in Canada often  include ‘massage therapy‘, but don’t distinguish between what parts of massage constitute the therapy, and what parts just make you feel good. This is not surprising. The distinction can’t be made because there is no evidence to support the claim that massage therapy has any therapeutic effect.  Therapy has become anything that makes you feel good regardless of effectiveness.

Which means there is no fraud, at least on the part of beauty spas. Spas submitting claims for massage therapy, signed by a massage therapist, are not committing fraud and certainly no fraud the insurance industry wasn’t willing to tolerate when it was saving them money.  Now that it is costing the insurance companies,  they are calling it theft.

Hmmmm. The alarm expressed by insurers seems to be doing little more than covering up the real fraud, the fraud in which people can pay with their lives. That’s the fraud of alternative and complimentary medicine. Perhaps one day, the  CBC will investigate that, and its own role, and those of the insurance companies, in promoting worthless treatments to the naive and desperate.

CONFLICT OF INTEREST

In the meantime, a mea culpa. I have a personal interest in this story.  My wife has a benefit plan that includes coverage for many of these phony alternative medical practices, including massage therapy. Three or four times a year she trots down to the spa at the Hyatt Hotel in Calgary and treats herself to a day of indulgence courtesy of her benefits plan insurer and Alberta taxpayers.

She reports that the spa at the Hyatt is terrific, comes home feeling great and without any delusions concerning therapeutic effects. The phrase we use at our household is . . .  Hey, if they are dumb enough to pay for it. I like it when my wife is happy and feeling spoiled, especially when someone else pays.  So I would definitely like this to continue.

Further to this, as a Reiki Master, I am still working on my holistic Margarita Therapy (1/3 tequila, 1/3 orange liquor and 1/3 freshly squeezed lemon or lime juice over ice).  No word yet on insurance coverage but I promise to keep you all posted. It’s homeopathic – I swear!

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