Friday
September 19, 2014

Homework Help: HIM

Posted by abed on Saturday, March 29, 2014 at 3:58am.

Case Discussion
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, has decided to bill Dr. Pearsonís services under the Medicare number of Dr. Craig (another Central City physician) until Dr. Pearsonís credentialing process has been completed, and habitually submits a claim more than once if she isnít sure whether it has already been submitted or not.
1. Name the types of fraudulent billing that Meredith is conducting.
2. Could Meredith be held liable for these activities?
3. Is Dr. Pearson subject to liability although he doesnít know Meredith is conducting these activities?
4. Once Meredithís activities are discovered, how should her conduct be addressed by her employer, Central City Internal Medicine?
5. What should Central City do to ensure these types of problems donít occur in the future?

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