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Background: Some physicians seem to be willing to sanction deception of insurance companies. Little is known about public attitudes regarding this practice. Objective: To assess public attitudes regarding physician deception of insurance companies. Design: Cross-sectional survey using clinical vignettes. Setting: Philadelphia County Courthouse, Philadelphia, Pennsylvania. Participants: Convenience sample of 700 prospective jurors. Measurements: Participants were asked whether, in response to restriction of health care, a physician should 1) accept restriction, 2) appeal restriction, or 3) misrepresent a patient's condition to obtain the desired service. The proportion of respondents reporting that the physician should misrepresent a patient's condition was determined. Results: 26% of respondents sanctioned deception, 70% supported appealing, and 4% supported accepting the insurance company decision. Among the 27% of respondents believing physicians have inadequate time to appeal coverage decisions, 50% sanctioned deception. Conclusions: Sanctioning of deception was substantial in this sample of prospective jurors. Preferences regarding insurance company deception are related to perceptions of physician workload and may further pressure physicians struggling to balance advocacy with honesty.