Is an unnecessary doctor visit insurance fraud?

A close friend of mine had an MRI for some severe headaches. A week after the test, the neurologist's office called to setup an appointment for the results. My friend, who was obviously concerned, asked if she needed to be worried, and the nurse said that the test results weren't "red flagged." So, with that little info, the appointment was made for as soon as possible based on the doctor's schedule.

When my friend went in, the doctor didn't even show her the scan. He just said everything was fine, and to keep doing the things she had been doing to manage the headaches. The entire visit was done in 2-3 minutes. It was completely unnecessary and could've easily been handled by a nurse over the phone. Instead, my friend took off work, paid the $15 copay, and the insurance picked up another $100 to cover their reduced rate. An uninsured person would've forked out $200 for the privilege.

So, the question is, did this doctor do the right thing? Is he obligated to bring in the patient to explain the results, no matter how insignificant they might be? Or, is this borderline/full-blown insurance fraud? If not, I have no doubt this is one of many reasons insurance costs so much. But anyway... I'm curious if anyone in the insurance or legal business has any knowledge of this type of situation. Should she be calling her insurance company and reporting this doctor?

The doctor should've given the results over the phone. It's not illegal, but it's just wrong. And, if 'you're not part of the solution....then you're part of the problem." This doctor is part of the problem.

I doesn't know sound like fraud. But only the doctor knows for sure. And, there are lots of doctors that do things for that extra buck.

And, if your friend wants copies of her medical records or of the scan all they have to do is ask. It wouldn't hurt to get a copy of the scan and get a second opinion.

Unnecessary is in the eye of the beholder.

It's not fraud. The doctor did 'standard' procedures. It's not fraud, but it's a perfect example of what's wrong in our medical system - unnecessary MRI's, and unnecessary appointments following them.

did your friend ask to see the scan? probably not. this is not insurance fraud. i have been involved in insurance fraud cases, and this is not one.

So say the doctor shows her the scan, what would she do with this scan? She is not trained as a doctor on how to read this. He would have looked at it prior to her visit to determine if a problem or not.

And yes, the nurse could have possibly just told her that the results were negative, thus no appointment and time off from work, but you cant bill for a phone call.

But there maybe another consideration and that he wanted her there to explain any options and suggestions or if she may have had any questions on further treatment, he cant pass that off to the nurse. What if they just explained on the phone and later something happens and she files a malpractice claim on the doctor? Most likely that is the main concern for getting her there since everyone is suit happy today and the doctor has to protect his butt.

My guess is that in the future, she might inquire if this appointment is necessary or not.

good luck