Working in the billing department

 

 

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.

Should Nicki quit her job, speak to her supervisor, and/or go over her head to others in the chain of command? Explain and cite reasons for your answers.
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?
What laws, if any, are you familiar with that may help to protect Nicki? Explain your answer and detail the provisions of these laws.
In your mind, does this case present an issue of fraud, abuse, or both? Explain.
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.

 

Sample Solution

countries. ‘Free trade area covers all manufactured and agricultural products, although the timetables for reducing tariffs and removing quantitative restrictions and other non-tariff barriers differ, (Association of South Asian Nations, 2009 update on free trade). Due to entry of various industries in the market, infrastructures are improved in collaboration of state’s government and the industries for their market accessibility. Improvement of infrastructures such as roads, railways, communication, electricity, and social amenities by these industries serves as a gateway to developments in these countries. Increased developments results to increase in investments and thus a country realize its development goals of. Although a country does not benefit directly through revenues from tariffs and taxes, the industries help it to meet its development goals. , its development vision is addressed. Improvements of infrastructure such as transport, electricity and social amenities results to improvement of investment capacities of regions and countries, which in turn contribute to economic growth (Jovanovic??, 2013 p. 971). Policies that lift barriers on export and imports by lowering or elimination tariffs and duties encourage export and import of both goods and services to across the region. Developing countries are able to gain revenues from exports while imports supply them with necessary services and goods that are important in steering economic development. For example the European Economic Community elimination of import and export tariffs for its member states encouraged free movement of goods and services across the region in a common market (Bento, 2009 p. 73). Therefore, free trade has contributed greatly to development of small nations through improved trade that encourages export of goods and services without barriers.

Trade liberalization has increased countries integrations and as a result aid to trade inflow to developing countries in terms of technologies and capital has been increased. This has led to strong economic growth, which has been reflected by the increasing gross domestic product and exports for developing countries in East Asia, Africa and Latin America. For example, most of Latin America middle income level countries have integrated with developed countries such as china resulting to improvements of their financial system and consecutive developments (Chen, & Emile, 2013 p. 118). Consequently, technology transfer has led to shift to manufacturing industries, which has attracted investors to the countries. Technology has resulted to increase of improved productivity through lowered cost of production by lowering the cost of labour and increasing relative labour productivity. According to comparative advantage theory by Ricardo, a ‘country should concentrate on production of goods that is best suited at lowered cost in order to improve productivity and economy through export to a second country that is not good in production’ (Bento, 2009 p. 28). Developing countries have been able to achieve improved productivity and specialization through adoption of technologies that have been introduced in their countries by other developed countries through trade liberalization. For example, India h

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