Witness an AAPC Ethics Violation? Here Is What to Do

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  • February 22, 2016
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Witness an AAPC Ethics Violation? Here Is What to Do

Submission and Processing of an Ethics Complaint

If you believe an AAPC member has acted contrary to the AAPC Code of Ethics, explain the substance of the complaint in detail by following the information requirements below and forward it to the Ethics Committee by e-mail to ethics@aapc.com. The complaint should include:

  1. The name of the member or members who are alleged to have violated the AAPC Code of Ethics.
  2. The member ID number of the member or members who are alleged to have violated the AAPC Code of Ethics (if known).
  3. A detailed description of the conduct that you believe violates the AAPC Code of Ethics. Details should include what happened, when it happened, and where it happened at a minimum. The identity of others who might corroborate the allegations should be provided.
  4. Information/documentary evidence supporting the allegations of misconduct. In cases where the conduct violates a statutory provision of the law, a certified copy of the final judgment from a court of competent jurisdiction or administrative agency is required before the Ethics Committee can proceed. As an example, allegations of fraud must be supported by either a civil or criminal court judgement that is not subject to appeal. Allegations that the member violated HIPAA must be supported by a final determination by the U.S. Department of Health & Human Services (HHS) Office of Civil Rights.
  5. Whether you wish to remain anonymous.

The Ethics Committee investigates submitted complaints based on the information and evidence presented. The committee does not conduct factual investigations and cannot make determinations regarding whether the alleged conduct violates a state or federal statute or regulation. It is the responsibility of the complainant to provide sufficient evidence of the misconduct for an ethics case to proceed. Mere allegations of misconduct will in most cases, be dismissed where additional supporting evidence is not provided.
If a complaint demonstrates a credible prima facie violation of the AAPC Code of Ethics, the committee chair will appoint one of the AAPC Legal Advisory Board members of the Ethics Committee as the investigating member of the case. That individual is responsible to provide the involved member with a Notice of Complaint, which affords the member the opportunity to submit a rebuttal statement and evidence. When that information is received, the investigating member is charged with determining whether the information warrants submission of the matter to the Ethics Committee for a hearing.
Where referral to the committee for a hearing is not justified by the evidence submitted, the complaint is dismissed and the complainant and member are notified so.
Where referral to the committee for a hearing is warranted, the committee chair is responsible to schedule a hearing at a time convenient to all committee members.
In most cases, hearings are held within 60 to 90 days. Following the hearing, the complainant and the member are notified of the committee’s determination.

Michael Miscoe
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Mr. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA has over 20 years of experience in healthcare coding and over sixteen years as a compliance expert, forensic coding expert and consultant. He 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 has an extensive national speaking background and has been published in numerous national publications on a variety of coding, compliance and health law topics.

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