In this discussion, you are to review the following ethical and legal dilemma:
A solo-practice provider has been practicing in a specific area for 19 years. At 20 years, the staff, several of whom have been with the doctor since the start, can collect retirement through a contracted vendor. However, due to a diminishing of insurance reimbursement, the doctor cannot keep the doors open any longer. The provider realizes that both her and her employees are unlikely to find employment that will provide for any means of financial security in their aging years. Attempts at marketing and attracting additional clients have been unsuccessful as a result of managed care contracts and preferred provider arrangements that have gone to hospital-based physicians. There are no other options, save one. The provider knows that if she upcodes the visits and charges more, she can keep her doors open and retire in a short 12 months.
In your main discussion post, discuss the current dilemma from the perspective of the provider and from the perspective of the staff. Are there any gray areas to this dilemma? If so, can you understand why a provider would be tempted to upcode? Unfortunately, this dilemma is happening across America.
Must be 75 to 150 words