Instructions:
You are the finance manager in a long term care facility that is struggling to remain solvent. The facility’s administrator has hired a consultant to work with you to increase Medicaid reimbursement. The consultant recommends that you be more “liberal” in coding the severity of residents’ needs to justify greater reimbursement. The consultant tells you, “everybody does it” and, “it’s an undetectable way to boost revenue”.
You believe this approach is somewhere between inappropriate and illegal. You know the consultant is being paid on a commission and is an old college buddy of the facility administrator. You also recognize that your facility could soon go out of business and leave you without a job.
In a two page paper, respond to the following:
What are your ethical challenges?
What are your options?
What is your chosen course of action?
What will probably happen as a result of this course of action?
Requirements:
- 2-3 pages in length (not including cover and reference pages)
- A minimum of three outside resources (one of these resources can be your textbook)
- Your paper should be formatted according to APA, include a proper introduction, appropriate headings, and conclusion.
Expert Solution Preview
Introduction:
The given scenario presents an ethical dilemma for the finance manager of a long-term care facility who is recommended to manipulate the coding of residents’ needs to increase Medicaid reimbursement by the consultant. The finance manager is faced with challenges of ethical conduct, conflicting interests, and potential job loss. In this answer, we will explore the ethical challenges, options, and the chosen course of action for this situation.
What are your ethical challenges?
The finance manager is confronted with several ethical challenges in this scenario. Firstly, the consultant is recommending a potentially fraudulent practice, which could result in the facility submitting false claims and intentionally misrepresenting the acuity of the residents’ conditions. Secondly, the finance manager is aware of the inappropriate behavior of the consultant, who is likely driven by self-interest, i.e. commission, and threatens the integrity of the financial administration of the facility. Finally, the finance manager faces personal ethical challenges by participating in illegal activities that could compromise their professional and personal integrity.
What are your options?
The finance manager has several options in this scenario. Firstly, they can comply with the consultant’s recommendation to manipulate the coding process and boost Medicaid reimbursement, risking the possibility of facing legal repercussions. Secondly, they can reject the proposal and avoid engaging in fraudulent behavior, thereby negatively affecting the financial performance of the facility and facing potential job loss. A third option is to report the consultant’s recommendation to the facility’s governance board, pertinent regulatory agencies, or to report it to higher authorities for anonymous reporting options.
What is your chosen course of action?
The finance manager should choose the option of rejecting the proposal and not engaging in fraudulent behavior. The manager must uphold ethical conduct, perform their duties in compliance with the law, and maintain the integrity of the facility’s financial administration. It would be prudent for the manager to educate the consultant on the legal and ethical implications of their proposed recommendation. The finance manager should make this decision known to the facility’s administration and report the consultant’s ethical and legal violation to the appropriate regulatory agencies.
What will probably happen as a result of this course of action?
The chosen course of action in this scenario will likely lead to several outcomes. Firstly, there could be a negative financial impact on the facility, endangering its solvency and potentially leading to job loss for employees. Secondly, the administration may require further investigation to identify the misconduct of the consultant and exercise corrective actions that may help prevent the occurrence of such ethical misconduct in the future. Reporting such illegal and unethical conduct will be an opportunity to prioritize ethical practice that will preserve human life while preserving the financial health of the facility in the long run.
