Nicki has been working in the billing department for a large non-profit healthca

Nicki has been working in the billing department for a large non-profit healthcare organization for two and a half years and was just promoted to Senior Medicare Billing Specialist. Since Nicki has been dealing with Medicare for over two years, she jumps right in and continues with the same billing practices she has been using and trains her staff with these techniques. Because Nicki’s new position allows her to view information that she was not previously privy to, she has started to notice some discrepancies surrounding the way many of the Medicare treatments and procedures are coded. She pulls several of the EOB (explanation of benefits) statements and shows them to her supervisor. The supervisor informs her that this is how they will continue to code these treatments and that she should focus solely on training and monitoring her staff. Nicki finds the response she received to be very strange but nevertheless, she goes back to her work. Six months pass and Nicki has grown more distraught as she has collected literally thousands of EOBs that are coded incorrectly, allowing more reimbursement than allowed (known as upcoding), but there is nothing she can do to change them at her level. She does not feel comfortable approaching her supervisor again, and she is concerned that going higher up the chain of command may make it even worse. To compound the problem, Nicki reads in the local paper that another facility in the system in which she works in is being investigated for Medicare fraud. After researching current, credible sources surrounding fraud and abuse in healthcare, use the following questions as well as your research to outline a path for Nicki to follow: Should Nicki quit her job, speak to her supervisor, and /or go over her head to others in the chain of command? What is a Corporate Compliance Officer and if an option, should they be consulted? Explain and cite reasons for you answers. Nicki has kept thousands of documents that she believes are fraudulent in nature. What should she do with these? Should she provide them to her supervisor? The media? Why or why not? What laws, if any, are you familiar with that may help to protect Nicki? Explain your answer and detail the provisions of these laws. In your mind, does this case present an issue of fraud, abuse, or both? Explain. Outline a path for Nicki to follow. Include the following in your outline: Introduction to the problem Analysis of the facts Laws that are important to this case Ethical issues Determination of the wrongdoing Evaluation of what should be done Conclusion Submission Details: Submit your answers in a 2-3-page Word document, not including the title and reference page. Use the outline for this assignment to ensure you have met all requirements. Make sure you are using APA format and citing your references. Review the rubric assessment prior to completing this assignment for further instructions. Name your document HCM2004_W4A_LastName_FirstInitial and submit to the Submissions Area by the due date assigned. Reference

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