How to Fake Heart Disease

One of the great medical frauds of recent years was the faking of heart disease to hornswoggle insurance companies. The story of this fraud was definitively told last week in the Annals of Internal Medicine by Dr. O. F. Hedley of the U.S. Public Health Service. The swindle reached its climax in 1937, involved a gang of some 240 people (including at least 25 doctors). Hundreds of thousands of dollars in disability claims were paid out, by more than 40 insurance companies.

The fraud, centering in New York City, was largely promoted by two shyster law firms. The lawyers' "runners" sought out "small businessmen . . . in financial difficulties because of the depression," told them of an easy way to make money. Heart disease, Dr. Hedley pointed out, "is easy to simulate and difficult to disprove," and juries tend to sympathize with the claimant. So the lawyers hired doctors to coach policyholders how to feign heart attacks and symptoms of coronary arteriosclerosis with angina pectoris.

The policyholders were often given digitalis, a drug which changes normal heart action. Then they would be told to go on a spree, drink lots of coffee, run to a doctor's office (upstairs if possible) for an electrocardiographic heart examination. Such going-on often made their heart action temporarily quite erratic. Heart attacks were often faked in public places, and the "victim" taken to a hospital. Both specialists and insurance doctors were fooled.

But success made the swindlers overbold. Well-satisfied claimants went to work for the lawyers, drummed up new business for a cut of the profits. The law firms which ran the racket even began a price war. The lawyers also became less careful in the selection of clients. Persons not only in the 50s but also in the 40s and even 30s were making claims for disability from heart disease.

The growing epidemic of heart disease among younger men aroused suspicion among insurance doctors. Proof of the fraud was finally obtained when claimants were kept in hospitals until their drugged hearts returned to normal. But for several of the swindlers the story had a sharper moral: they found that their hearts had really been injured.

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