Him-M 108 Health Information Management- Assessment Answers

1. Care One is a well-known medical practice that serves a rural community that does not have a hospital. The physicians must admit patients to a hospital in the next town that is 30 miles away. Dr. Caremore is one of the most well-respected and well-loved physicians in the community, and people feel he is the best physician in the community. Dr. Caremore has learned that sometimes he must exaggerate a patients conditions in order for the patient to be admitted to the nearby hospital and he often times has his office staff call 911 in order to have patients transported from his office to the nearby hospital. He has told the nursing staff that he does this to try to make the patients appear sicker than they might be in hopes that the patient will meet the medical necessity requirements for admission. Dr. Caremore knows sometimes the patients family needs a break from caring for the patient and a few days in the hospital is often a big help to family members. He does not want them to have to drive 30 miles away to the hospital to be sent back home.

 

You are the office manager for the practice and one of the nursing staff comes and reports the scenario to you.

 

What do you do?

 

Is this a problem?

 

2. Dr. Pearson has recently been hired into the Central City Internal Medicine Group as its fifth physician. He has recently completed his residency and is eager to enter private practice. Dr. Pearson is introduced to Meredith and Dawn, two members of the billing staff for the practice. Unbeknownst to Dr. Pearson, Meredith financially assists the practice in several ways. She bills procedures by using individual codes instead of comprehensive codes, she has decided to bill Dr. Pearsons services under the Medicare number of Dr. Craig (another Central City physician) until Dr. Pearsons credentialing process has been completed, and habitually submits a claim more than once if she isn't sure whether or not it has already been submitted.

 

Name the types of fraudulent billing that Meredith is conducting.

Could Meredith be held liable for these activities?

Is Dr. Pearson subject to liability although he doesn't know Meredith is conducting these activities?

Once Merediths activities are discovered, how should her conduct be addressed by her employer, Central City Internal Medicine?

What should Central City do to ensure these types of problems don't occur in the future?

 

3. Why should HIM professionals be aware of laws affecting the management of personnel?

 

4. The Equal Employment Opportunity Commission (EEOC) website, introduced in the text, describes a number of discriminatory practices that are prohibited by a variety of laws. Which of these do you think creates the greatest liability concerns for a healthcare manager? Consider your response, in particular, to the demographics of the area in which you live.

 

5. Discuss the Immigration and Reform Act of 1986 and what an employer must be aware of in order to be in compliance with other discrimination laws.

 

6. What is the difference between exempt and nonexempt employees? If you had a choice, how would you like to be classified and why?

Answers

1: Case study of Care One and Dr. Caremore

It is to be mentioned that the practice of exaggerating a patient’s condition to get them admitted in the hospital is a medical malpractice on the part of doctors.  As a manager of the Care One, it can be said that this malpractice needs to stop. Firstly proper investigation needs to be done to verify the truth of the allegation against the doctor. Proper investigation includes questioning Dr. Caremore about this malpractice. If it is established that such mal practice has been committed, warning must be given to the doctor to prevent the occurrence of any such incident in the future.

2: Case study of Dr. Pearson and Central City Internal medicine group

The act of billing Dr. Pearson in the Dr. Craig can be called Utility fraud. It is to be mentioned that offices often bill noncredentialed service providers under another credentialed national provider identifier till such service provider gets credentialed. However, it is to be mentioned that such practice is considered unethical and mal practice which could result in audit recoupment. Central City Internal Medicine Group must address this issue and give warn Meredith so that she does not bill Dr. Pearson under another doctor’s name. The aforementioned medicine group must make sure that all service providers are billed under care-rendering national provider identifier. Dr. Pearson needs to be billed under a new name with a new tax id.

3: Need of Him Professionals to be aware of laws affecting management of professional

HIM professionals should be aware of laws affecting the management of personnel as Health information management professionals work with various workforces and in a variety of setting. It is to be mentioned that Health Information Management personnel work act as bridges connecting clinical operations and to administrative functions. Having skilled HIM professionals helps to maintain confidentiality, integrity and security. Therefore it can be stated that it very important for HIM professionals to be aware of the laws affecting the management personnel.  

4: Equal Employment opportunity commission

The purpose of this commission is to ensure that the federal laws of the United States of America are enforced if any discrimination happens against any job applicant and employee. The grounds of discrimination include race, color, sex, age, disability and origin. Therefore, it can be stated that Healthcare managers will be held liable if they discriminate against employees on the aforementioned grounds. It can be stated that the aforementioned commission has the power to conduct investigations if they receive complaints of discriminations from employees.  

5: Immigration Reforms and Control Act 1986

The Immigration Reforms and Control Act 1986 was enacted on 6^th November 1986. The Act stated that Employers are required to attest their employees’ immigration status. It also made it illegal for employers to hire illegal immigrants. It is to be mentioned that every employer who has at least fifteen employees working for him must ensure that no discrimination on the grounds as stated in the Equal Employment commission happens against any employee to avoid facing legal charges.

6: Exempt and Non Exempt Employees

Non exempt employees are those who are entitled to overtime pay according to the Fair labor standards Act. They are entitled to receive one and half times the regular pay when they work for more than 40 hours a week.

Most common examples of exempted employees are white collar exemptions. The administrative employees, executives, computer professionals are examples of exempt employees. However it is to be mentioned that given a choice it would be best to be categorized as a Non-exempt employee as non exempt employees are entitled to overtime work.

Reference List:

Connolly Jr, W.B., Connolly, M.J. and Feinstein, J., 2017. A practical guide to equal employment opportunity. Law Journal Press.

Baker, S., 2013. Effects of immigrant legalization on crime: The 1986 immigration reform and control act. Discussion Papers, pp.12-012.

Weaver, C.A., Ball, M.J., Kim, G.R. and Kiel, J.M., 2016. Healthcare information management systems. Cham: Springer International Publishing.

Zimmer, M.J. and Sullivan, C.A., 2017. Cases and materials on employment discrimination. Wolters Kluwer Law & Business.