Working in the billing department for a large, for-profit health care organizati

Question

Working in the billing department for a large, for-profit health care organization has been a dream come true for Nicki Knowitall and she is excited about her future opportunities. Nicki has been with the company for two and a half years and was just promoted to senior Medicare Billing Specialist. Since Nicki has been dealing with Medicare for over two years, she jumps right in and continues with the same billing practices she has been using and trains her staff with these techniques. Because Nicki’s new position allows her to view information that she was not previously privy to, she has started to notice some discrepancies surrounding the way many of the Medicare invoices are coded. She pulls several of these invoices and shows them to her supervisor. The supervisor informs her that this is how they will continue to code these documents and that Ms. Knowitall should focus solely on training and monitoring her staff. Nicki finds the response she received to be very strange, but nevertheless, she goes back to her work. Six months pass and Nicki has grown more distraught as she has collected literally thousands of invoices that are coded incorrectly, but there is nothing she can do to change them at her level. She does not feel comfortable approaching her supervisor again, and she is concerned that going higher up the chain of command may make it even worse. To compound the problem, Nicki reads in the local paper that another facility in the system that she works in is being investigated for Medicare fraud.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.

2. What if Nicki quits her job and moves away?

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?

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.

Explanation / Answer

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.

Niki should talk to her supervisor again and inform that she will talk to the top management if she does not receive a proper response from the supervisor. It is always good to keep the immediate manager of all the happenings at work. She cannot keep quiet as well as she knows that there is something wrong with what the organization is doing. Once the issue does not get a proper response then the involvement of top management is very much required to maintain a low profile and avoid being caught by correcting the mistakes made.

2. What if Nicki quits her job and moves away?

Nicki can quit her job and move on but she will be questioned when the government catches the facility where she is working for fraudulent activities. She has worked in the organization for more than2 years and that is enough for the police to doubt her credibility and question her for all the activities. So it is better for her to stay with the company and sort the issues.

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?

She should keep a copy of it and submit the documents to the supervisor and also the management of the company. If they try to neglect the issue and try to cover it up by giving lame reasons then she should think about talking to media and expose what the company is doing.

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.

There is whistleblower protection act that can save Nicki and it will make her receive an appreciation for what has done for the society. Under this act, any person will have the right to tell the world when an organization is involved in any kind of misconduct. It supports the freedom of speech of the workers in an organization. The workers will have the right to complain when they have enough evidence to support their claim.

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