Who you gonna call
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School
University of Cincinnati, Clermont College *
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Course
0223
Subject
Health Science
Date
Dec 6, 2023
Type
docx
Pages
3
Uploaded by ColonelEmuPerson974
1.
Should Nicki quit her job, speak to her supervisor, and/or go over her head to
others in the chain of command? Explain your answers.
I don’t believe Nicki should quit her job right away. It is important that these issues
are addressed and given that Nicki has been involved in the issue she has a
responsibility to address it. Nicki is in a position to gather evidence to be able to
reasonably deal with the issue prior to leaving the job. She should attempt to speak
with her supervisor again about the issues and ensure that her supervisor
understands the severity of it. Additionally, providing evidence regarding the
incorrectly coded invoices and the violations could help in proving the point to her
supervisor. If the supervisor dismisses her at this point, Nicki should bring the issue
to those higher in the chain of command and see what action is taken.
2.
What if Nicki quits her job and moves away?
Legally Nicki has no obligation to remain at the job and stay in the area, ethically she
should address the issue prior to quitting her job. By quitting and not ensuring the
issue is addressed the organization is getting to sweep the fraudulent billing under
the rug and continue with it. Nicki should make a reasonable effort to address the
fraudulent billing prior to leaving her job. However, if she chooses to leave the job
she should address it indirectly by reporting it to the right avenue.
3.
Nicki has kept thousands of documents that she believes are fraudulent in nature.
What should she do with these? Should she provide them to her supervisor? The
media? Why or why not?
Nicki should not provide these documents to her supervisor or the media. Providing
these documents to her supervisor or media opens up the potential to interfere with
the evidence. Nicki should ensure that she has copies of these documents to be
safe. Consulting with an attorney using these documents may also smart. Nicki
should ensure that she is protected as she could be considered a whistleblower.
There are legal protections for whistleblowers.
4.
What laws, if any, are you familiar with that may help to protect Nicki? Explain
your answer and detail the provisions of these laws.
Laws do exist to protect Nicki. The Whistleblower Protection Act is put in place to
protect employees, like Nicki, who address instances of misconduct within an
organization. With this act it is illegal for action to be taken by an employer against
an employee who reveals misconduct or illegalities taking place in a workplace.
5.
In your mind, does this case present an issue of fraud, abuse, or both? Explain.
This case represents an issue of both fraud and abuse. It is fraud because the
organization is knowingly incorrectly coding the Medicare invoices. The services that
have been rendered are not being documented correctly therefore reimbursements
are not correct. It is an abuse of power on the organizations part due to the
continued use of incorrect billing practices despite the issue being brought up. The
supervisor has been told of the issue and has made it known that they do not plan
on addressing the issue.
6.
Pretend that you are Nicki. You want to do the right thing, but you aren’t sure
what that is. Where do you start? Outline a path for Nicki to follow.
Nicki could consult with an attorney regarding the issue. The attorney can help in
pointing Nicki in the right direction. The attorney should be someone who has an
understanding of Medicaid fraud and whistleblowing. Nicki should take the evidence
she has gathered so far and show it to the attorney.
7.
Think about your own experiences, no matter the working environment: Have you
had to deal with issues of dishonesty? How have you handled it? What resources
were or were not available to you?
I have not personally had to deal with any practices of dishonest in a work
environment. However, putting myself in Nicki’s shoes I can see how this is a difficult
situation to address. It is clear that others are aware of the unethical practices,
however, Nicki appears to be the only one thinking about addressing the issue. This
can be scary and intimidating. Generally, when I have had an issue in my workplace
that I am not sure how to address I have first sought the help of a direct supervisor.
Unfortunately it appears that Nicki is not getting any help from her supervisor in this
case.
8.
Depending on your decision, i.e., do you leave, do you stay, do you do nothing,
etc., are you liable if legal action is taken? Why or why not? Explain any actions that
may be taken.
As long as Nicki seeks appropriate legal help and continues to act legally and
ethically herself I believe she should stay and see to it that the issue is addressed.
Of course this is easier said than done as it can be difficult to remain in an
environment that appears toxic. If Nicki does choose to leave the job she should
continue to be available to help out to address the issue if needed. For example, she
should report the issue to the appropriate authorities and make herself available to
testify or complete any action needed. Leaving the job and not taking any action may
make her look guilty as well, especially if she leaves the job and moves away.
Reference
Buchbinder, S.B., Shanks, N.H., and Kite, B.J. (2021).
Introduction to healthcare management.
Jones & Bartlett Learning. LLC.
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