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HIM M 108 Introduction To Health Information Management

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  • Course Code: HIMM108
  • University: Indiana University

    MyAssignmentHelp.com is not sponsored or endorsed by this college or university

  • Country: United States


1. Care One is a well-known medical practice that serves a rural community that does not have a hospital. The physicians must admit patients to a hospital in the next town that is 30 miles away. Dr. Caremore is one of the most well-respected and well-loved physicians in the community, and people feel he is the best physician in the community. Dr. Caremore has learned that sometimes he must exaggerate a patients conditions in order for the patient to be admitted to the nearby hospital and he often times has his office staff call 911 in order to have patients transported from his office to the nearby hospital. He has told the nursing staff that he does this to try to make the patients appear sicker than they might be in hopes that the patient will meet the medical necessity requirements for admission. Dr. Caremore knows sometimes the patients family needs a break from caring for the patient and a few days in the hospital is often a big help to family members. He does not want them to have to drive 30 miles away to the hospital to be sent back home.
You are the office manager for the practice and one of the nursing staff comes and reports the scenario to you.
What do you do?
Is this a problem?
2. 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, she has decided to bill Dr. Pearsons services under the Medicare number of Dr. Craig (another Central City physician) until Dr. Pearsons credentialing process has been completed, and habitually submits a claim more than once if she isn't sure whether or not it has already been submitted.
Name the types of fraudulent billing that Meredith is conducting.

Could Meredith be held liable for these activities?

Is Dr. Pearson subject to liability although he doesn't know Meredith is conducting these activities?

Once Merediths activities are discovered, how should her conduct be addressed by her employer, Central City Internal Medicine?

What should Central City do to ensure these types of problems don't occur in the future?
3. Why should HIM professionals be aware of laws affecting the management of personnel?
4. The Equal Employment Opportunity Commission (EEOC) website, introduced in the text, describes a number of discriminatory practices that are prohibited by a variety of laws. Which of these do you think creates the greatest liability concerns for a healthcare manager? Consider your response, in particular, to the demographics of the area in which you live.
5. Discuss the Immigration and Reform Act of 1986 and what an employer must be aware of in order to be in compliance with other discrimination laws.
6. What is the difference between exempt and nonexempt employees? If you had a choice, how would you like to be classified and why?
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