Reference no: EM133656154

When Babs, a hospital patient, was treated for breast cancer, her physician obtained her informed consent to use a new treatment that he had helped develop. A drug was injected into her breast that targeted for destruction just the small malignant tumor; no healthy tissue was destroyed. Babs's medical insurance company refused to pay for the procedure, claiming it was "experimental." The procedure was new, but Babs's physician had used it many times with success. "Can't you just say I had a traditional lumpectomy," Babs asked Christine, "so my insurance company will pay for it?"

"We had to explain to Babs that this would constitute insurance fraud, and we couldn't do it," Christine explains.

1. From Babs's perspective, she wanted her insurance company to help pay for the expensive procedure. From Christine's perspective, lying about the procedure performed was not only illegal, but it was also unethical. Why did Christine see Babs's request as insurance fraud?

2. What would you recommend to Babs in regards to paying for the procedure, and for the practice to obtain reimbursement?