Participant #4

Title: Fraud & Abuse- Help Me, the Feds Are Coming!
Survey questions
Our finance friend needs our help, so lets see if we can answer a few questions for
him. Before we begin, it is necessary to remember that fraud and abuse, or what
has come to be known as the two-headed monster, are really two distinct violations
that can be enforced. Fraud is an intentional act of deception, while abuse is
improper behavior not consistent with standard practices. As to abuse, it does not
matter if the act was unintentional, it will be punished the same way. With that in
mind, lets see if you can answer the following key discussion questions and then
provide a remedy for our finance friend.
1. First do you think that there are any indications that either fraud or abuse has
occurred? If so, provide examples of each and discuss what makes them fraud and
what makes them abuse.
I do think fraud and abuse has occurred because as stated, the certain
employee thinks it benefits the hospital, the worker and the patients as
well. The worker at the hospital believes in reform but it committed fraud
in the process by changing code in order to a get a bump in their
paycheck. This is not following legal protocol even if others are do the
same as well.
2. Do you think that our friend has anything to fear? Is he an innocent bystander
who is truly unaware of his actions? Does it matter?
Yes the worker should not afraid of anything that goes down but he is not
an innocent bystander because he did have a clear state of mind when
changing the bill codes when he report if they are is problem and makes
sure it get addressed without changing the bill code. Meaning it does
matter, fraud and abuse of power is not something that should be
addressed lightly.
3. What legal implication is his lawyer friend referring to when he tells him to
come clean explain what he has been involved with? What do you think about
this approach, and do you think that he would be protected?
I am honestly not sure because he did not report the problem with the
procedures are not covered. I believe he should come clear with
everything he has done concerning changing the billing code to get paid
and a bonus as well. It better to come out with the truth that hide because
it soon be revealed and make him look much more guilty and put him a
really tough situation and lawyer is friend but i am sure he can hide it to
protect him.
4. Speak to the coding issues were mentioned in the case. What implications are
there for this type of behavior?
The issues should be fixed and more issues are caused by manipulating
the billing codes to get paid. There is a lot of risk involved in that,
especially for the hospital. It can cause reputable damage in the long run.

5. What about Rosys advice? Is it sound? Does it speak to the legality issues
required to meet fraud and abuse charges?
Her advice was not really morally sound because how would not know
what you are doing if you are clearly lucid. Meaning if he question he
should lie and state he didnt know what he is doing because changing the
billing codes are protocol and are previous ones are a mistake. Yes, it the
reason there are some much issues and may result in great consequences
for the worker in the hospital.
6. If you were in the position that our finance friend is in, what would you do?
What is the best advice you can provide?
I would report the coding issues and not change the billing codes because I will be
upfront with all issues that are apparent and adhere to the rules. They are put in for
for a reason.
7. Based on your knowledge of the topic and case reviews, what do you think
the outcome of a case like this will be? If there are penalties, what will they
be?
He probably would either be question with penality if the worker ends up lying and
stating he didint know it was apparently worng or he will tell the truth and be
charged with fraud and any other penalties.
8. Do you think our friend should be updating his resume and looking for a new
job? Or should he be thinking about how hell be making new friends in jail?
If he somehow does not end up in jail even if he tells the truth about the billing
codes. He should not work were illegal affairs are occuring in the workplace. He
should look for a new job.
Instructions: Give as much detail and be thorough as much as possible in each
question. Your opinion is very valuable!