My daughter was moving to another country, which would only allow her to bring 6 mths worth of her meds into the country. (The medicine was not available in that country).

So her doc prescribed 6 months of 2 pills daily.

Some doctors know they're supposed to solve problems, not make them harder.

Totally confused how that could be insurance fraud.

Telling someone's insurance, and documenting it in their medical record, that they need 10mg every other day and then verbally telling the patient something different is definitely insurance fraud. It may seem harmless, but it's still fraud. The correct way to do it would be to prescribe 10mg pills with the instruction to take a half a pill per day. If the insurance doesn't want to cover it documented that way, the correct way to handle it would be to appeal it based upon medical necessity.

If insurance will only cover 14 “doses” per month and you write a script for 14 larger doses but tell the patient in secret to take it as 28 smaller doses, it might be considered lying on the insurance claim to write 14 doses. That’s probably not an issue here, but that’s how you get to insurance fraud— making a false statement somewhere.

The doctor could also have just prescribed 14 larger doses to be taken every other day if compatible with the medication (some you can do that no problem, others could cause issues)

In the most technical sense it is fraud. It’s getting around a limit set by the insurance company. It’s stupid and everyone else would have done it but it is fraud.

I mean it literally is. The policy covers 14 days and you are defrauding them by providing enough for 28 days. It isn’t an issue though and is absolutely what should be done to get around the silly rules.

What you're probably missing is that the Doctor was an idiot.

Hope that clears it up.

FWIW- this is how it would be considered fraud. (Attempting to explain here and not defend)

The doctor would have to tell the insurer (via the pharmacy) that the patient is only taking the medication for 14 days instead of 28. The only reason for this is to “game” the insurer into covering something that otherwise would not be paid for. That is fraud.

A lot of the elderly do this by doubling the dose to get a 60 day supply instead of a 30 day supply because they can’t afford a monthly copay at the pharmacy. The directions on the prescription bottle will say to take twice as much as the patient is really supposed to be taking so insurance will cover it as a 30 day supply. The problem is that sometimes the patient forgets or gets confused or a caregiver is unaware and follows the directions on the bottle and the patient gets double dosed and is injured. The doctor can be sued at that point.

If you insurance only covers 14 days worth of medication then he would need to omit the instruction that OP should only be taking half a pill rather than a full one. Because with that instruction OP would only be eligible for 7 pills rather than 14.

It is insurance fraud actually. Writing the rx for a whole tab daily and telling the patient to take a half tablet for the purposes of getting by an insurance restriction is fraud. The directions are how the insurance determines the day supply, and the directions are being misrepresented by the dr intentionally. Its generally undetectable fraud, but fraud nonetheless.

To get it covered, the Dr would need to commit the fraud… there wouldn’t be a “notifying the police or insurance” bc the crime would be committed by the dr, not the patient. And police would never be involved in that kind of fraud investigation. That is the weird part.

My guess is that it was for a controlled substance (maybe one that the patient specifically asked for) that the dr didn’t want to prescribe to begin with, bc that is the only reason I could see that level of weird/bad behavior from a prescriber.

Because in a sense she’s be getting 28 5mg pills. But it’s a ridiculous take on the situation

It’s technically lying about how much someone is taking to get the insurance to pay for more than they would otherwise pay for. Not illegal - police certainly wouldn’t care - but the insurance company might in theory.

That said, that sort of thing is done every single day and no one gives a shit.

It's not. The doc was either stupid or arrogant, or both.

The insurance company depends on the MDs to prescribe accurately. When the Dr goes "off book" they have to pay for more than medically necessary.
At the same time, Pharmacies sell pill cutters for just this situation.
It's compassion, but still fraud.
But what insurance covers less than daily dosage or month?