Question: Is one permitted to deviate from the truth while filling out health insurance forms in order to receive financial benefits for an individual not covered by the policy?
Answer: A health insurance plan covers medical and other such services for members of that plan. This means that any coverage or rebate one receives as part of one’s plan is deducted from the profits of that company.
It is therefore clear that it is absolutely forbidden to fill out health insurance forms in an untruthful manner in order to receive financial compensation. This constitutes the grave prohibition of theft.
Similarly, if one’s plan offers certain benefits to its members, such as reduced cost eyeglasses, it is forbidden to represent the facts as though a member purchased these glasses in order to transfer this benefit to a non-member. This constitutes the prohibitions of lying and stealing.
A question is recorded in Responsa Mishneh Halachot (Vol. 17, Ch. 156) where a woman recently gave birth, and the baby needed to be hospitalized for several days. The doctor did her a “favor” and wrote that the mother was also suffering from some medical issue so she could receive another two extra days of care in the hospital. The mother inquired whether or not this was permissible.
Hagaon Harav Menashe Klein zt”l responded that this woman was required to return the cost of the entire hospital stay to the insurance company since payouts are made based on certain agreements and since she defrauded the company, she was not eligible for any payout. He writes very strongly about this issue. He concludes that it is absolutely forbidden to steal from a health insurance company, Jewish or non-Jewish.
Let us recount a true story that occurred not long ago:
There was an individual in Israel who contracted a severe illness and throughout the course of this illness, he needed to obtain multiple referrals and authorizations from his HMO and other organizations to cover the cost of his medications and treatments.
This patient met a woman by the name of Mrs. Hadas Yifrach who worked in the hospital where this patient was in-network. Since she was a kind and helpful woman, she helped this man through all the bureaucracy and helped him obtain all the requisite referrals and authorizations, thus saving him much heartache. Unfortunately, though, this patient passed away soon after.
During the Shiva, the deceased appeared to Mrs. Yifrach in a dream, and he looked very perturbed. After inquiring why he was so upset, the deceased replied to her, “We need to return the money!” As he handed her money, she awoke from her dream.
This dream repeated itself several times in the following days, until one time, at 4:00 AM, Mrs. Yifrach told her husband that she could not bear this anymore. As she started researching, she realized that the deceased had once visited a doctor before he was insured, and he therefore owed a small amount of money. She then went and paid the cost of the visit herself and, from then on, she never had this dream again.
Such incidents occur all the time. We must be aware that although Teshuva is beneficial for all sins, the most difficult of sins to atone for is theft, for Teshuva is not sufficient. One must actually return what one stole. Only very few people are granted permission by Heaven to appear to people in this world to help them return what they owe. Thus, one must be extremely careful never to take anything that does not belong to him and in this way, one will merit a wonderful share in the World to Come.
