A family complains about the cost of treatment. You propose splitting a single procedure across two dates so the insurer pays for more of it. Which ethical principle have you violated?

Correct answer: D. Veracity

• A. Autonomy concerns the patient's right to make informed decisions about their own care and is not implicated.
• B. Justice concerns fair distribution of care and non-discrimination in whom you treat. Defrauding an insurer is not primarily a justice issue.
• C. Beneficence is the obligation to act for the patient's benefit — arguably the motive here, which is exactly why the question is testing whether motive excuses the deception. It does not.
• D. CORRECT. Reporting treatment dates or procedure codes that do not reflect what actually happened is a misrepresentation to a third party. Veracity — truthfulness — is the principle governing honest representation to patients and to payers. This conduct is also insurance fraud and is criminally prosecutable, regardless of the compassionate motive.

Note: Veracity is the better answer under the ADA Code, which places truthful representation to third-party payers squarely under veracity. Worth raising with the group — and note that a genuinely ethical alternative exists: phase the treatment for real clinical reasons, or arrange a payment plan.