AAPC Committed to Ethical Standards

Members can rely on AAPC’s Ethics Committee to uphold honesty and excellence.

By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO

To help members remain ethical throughout their career, AAPC has established an Ethics Committee as a standalone entity responsible for evaluating alleged violations of the AAPC Code of Ethics and, when necessary, determining appropriate sanctions. AAPC’s Ethics Committee is comprised of eight members: Four from the Legal Advisory Board, two from the National Advisory Board, and two from the AAPC Chapter Association board. Ethics Committee members are selected by their respective boards.

Ethics Committee Working for You

When a complaint is submitted to the committee, a Legal Advisory Board member is appointed to investigate the complaint, gather information, and when necessary, refer the case to the other committee members for a determination. After the investigating member refers a case, the remaining members review the submitted information, which includes the complaint, any response from the member involved, and other investigatory information. The remaining seven members of the committee then vote as to whether a violation of the AAPC Code of Ethics occurred and, if so, determine the appropriate sanction to impose.

Cases Show What Crosses the Line of Ethics

To provide you with a better understanding of the Ethics Committee’s role in serving you, here are actual cases the committee has evaluated. They do not represent all cases, but will show you the types of cases we address. The cases have been stripped of identifying factors to protect members from embarrassment. To deter members from ethical misconduct, use these cases to educate yourself and other members of the type of conduct that’s contrary to the AAPC Code of Ethics.

Case No. 1

A test proctor inappropriately opened an extra examination booklet and was not completely forthcoming to the committee when responding to the Notice of Complaint.

Determination: The committee concluded a violation of the AAPC Code of Ethics occurred. The sanction was a letter of reprimand and permanent preclusion from serving as a test proctor.

Mitigating factors: No prior ethics related issues, expression of remorse and embarrassment, and no evidence that exam information was further disclosed.

Case No. 2

A member falsely represented possession of both AAPC and non-AAPC credentials.

Determination: The committee concluded a violation of the AAPC Code of Ethics occurred. Sanction was permanent revocation of membership and credentials.

Mitigating factors: No prior ethics related issues.

Aggravating factors: Member did not respond to the committee and took no action to correct the misrepresentations, once notified.

Case No. 3

A member falsely represented possession of a Certified Professional Coder (CPC®) credential in the signature block of email correspondence, falsified credential verification results from the AAPC website, and made multiple false statements to employer indicating possession of the CPC® credential.

Determination: The committee concluded a violation of the AAPC Code of Ethics occurred. Sanction was a 12-month suspension of membership and credentials.

Mitigating factors: No prior ethics related issues, and member sat for and passed the CPC® exam (having already passed a specialty examination) within weeks of misconduct.

Case No. 4

An AAPC curriculum instructor improperly obtained copies of the CPC® examination while serving as proctor, and created a study guide containing actual exam questions and answers. The instructor provided the study guide to students, allowing students to compete unfairly on the CPC® examination.

Determination: The committee concluded a violation of the AAPC Code of Ethics occurred. Sanction was permanent revocation of membership and credentials and loss of license to provide AAPC-approved curriculum instruction.

 

Mitigating factors:No prior ethics related issues and member was forthcoming to committee in response to Notice of Complaint.

Aggravating factors: The violation was considered especially egregious because the instructor was in a position to influence future members regarding ethical obligations as professional coders. The member’s actions compromised the integrity of the CPC® examination and devalued the CPC® credential by causing potentially unqualified individuals to obtain the CPC® credential, thereby justifying the imposed sanction.

Case No. 5

A coding instructor improperly obtained copies of CPC® and specialty examinations while serving as proctor. Copies of the examinations were allegedly provided to students, who then sat for the exams, completed them, and passed their respective CPC® and/or specialty examination in approximately three hours.

Determination: The committee concluded a violation of the AAPC Code of Ethics occurred. Sanction was permanent revocation of membership and credentials.

Mitigating factors: No prior ethics related issues.

Aggravating factors: Member was not forthcoming in the response to the Notice of Complaint submitted to the Ethics Committee. Member also interfered with the investigation by responding on behalf of the students. The violation was considered especially egregious because the instructor was in a position to influence future members regarding ethical obligations as professional coders. The member’s actions compromised the integrity of the CPC® and specialty examinations and devalued AAPC credentials by causing potentially unqualified individuals to obtain the CPC® or specialty credential, justifying the imposed sanction.

Case No. 6

A member misrepresented possessing a number of specialty certifications, as well as falsely having status as an “AAPC Approved Online Education Provider” on a publicly accessible development Web page.

Determination: The committee concluded a violation of the AAPC Code of Ethics occurred. Sanction was a letter of reprimand and instruction to remove inaccurate statements from the development page on the website.

Mitigating factors: No prior ethics related issues, forthright response, and committee determined there was no intent to deceive the public.

Considering the size of our membership, the incidence of improper conduct is extremely small. This suggests the vast majority of AAPC members are committed to upholding the ethical standards of our profession. Of the cases reported, the most common cases pertain to misrepresentation of credentials or experience needed to obtain removal of apprentice status; however, the recent cases involving improper conduct by instructors (and potentially students) involving AAPC examinations are the most disturbing. Those who are tempted to accept dishonest help should consider that cheating on an exam may get you a credential, but it doesn’t mean you have the skills needed to perform the job.

Instructors and proctors must understand that obtaining an exam and providing it to students doesn’t help the students. It may result in a high pass rate, but it does not mean the person is a good instructor.

Speak Up! Your Reputation Is on the Line

The AAPC Code of Ethics imposes a duty to report unethical conduct by another member. Silent acquiescence enables such conduct, and diminishes the credibility of all who have earned AAPC credentials.

If you want to file a complaint, but are concerned about retribution, know that the committee takes great pains to keep the identity of the complainant anonymous, when anonymity is requested. If you are aware of ethical misconduct, report it to the Ethics Committee via email at: ethics@aapc.com.

The Ethics Committee needs the help of all members in upholding the ethical standards of our profession by not tolerating unethical conduct.

Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, serves on AAPC’s National Advisory Board, Legal Advisory Board, and is chair of the AAPC Ethics Committee. He has over 20 years of experience in healthcare coding and over 16 years as a compliance expert, forensic coding expert, and consultant. Miscoe has provided expert analysis and testimony on a wide range of coding and compliance issues in civil and criminal cases and his law practice concentrates exclusively on representation of healthcare providers in post-payment audits as well as with responding to HIPAA OCR issues. He speaks and is published on the national level, addressing a variety of coding, compliance, and health law topics. Miscoe is a member of the Johnstown, Pa., local chapter.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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