Wiki What would you do?

Ozbaby

Contributor
Messages
14
Location
Medina, OH
Best answers
0
I am curious what the folks out here in the forums will do with this.

Let's say you start a new role with a practice that is not in compliance with nearly any coding rule or federal guideline. (And has never been.) You, being new, begin to explain what is necessary and why and work to institute changes to transform your new place of employment into a compliant one. You print guidelines, you hold in-services, you train staff, you work tirelessly and begin to see a light at the end of the tunnel when more and more faults are discovered. You find that certain services had been billed incorrectly for years, providers claimed services they themselves did not render, on and on. Your new role is much, much more than you imagined and is certainly different from the position that had been described to you initially. Nonetheless, you persevere.

Fast forward and it is already your one year anniversary. You were due for a performance bonus at 6 months that you never received. You email your boss (who is the owner of the practice) with a bullet list, per usual, in preparation for your upcoming meeting. It is a status report of more than a dozen items. You also mention the bonus you were to receive 6 months prior. In response, your boss blames you for the practice experiencing decreased revenue as a result of the "compliant" changes you made, tells you that the practice has been a disaster since you've joined, and writes that they cannot afford your salary and you are undeserving of any sort of raise. They pepper the email with further color by including a string of 19 exclamation points following one of the more hurtful sentences.

The next day, your boss must be feeling more human and send you a message to apologize. It is your turn to respond. What would you do?
 
Explain the fact that the office being out of compliance is not your fault, but it is your responsibility to help to clean up the mess. Also, mention to the owner that you have provided multiple instances where you have pointed out that there is fraudulent instances happening. People are always more willing to point the finger instead of taking ownership for their faults or for the faults of businesses by their own hands. Honestly, I would highly suggest an outside billing/coding audit from a reputable company and suggest that one is completed before an audit happens from someone like CMS. I went through a similar situation, and the privately owned urgent care I was managing decided to run an Asian grocery store from the break room within the urgent care.....I ended up realizing it wasn't worth me continuing to put myself in jeopardy and I cut my losses and resigned from the position. Once I resigned, I did put a call into the OIG to report what I had found because I felt an obligation since I knew they were doing a lot of things that were out of compliance.
 
Top