Question

Privacy, Security, and Fraud

Privacy and security of protected health information is mandated by law, and health care practitioners must know the law. Health care providers must also know the law concerning the prevention of theft of government health care monies via fraud.

Case:

Marie, a medical assistant working in a clinic is aware that one of her employing physicians consistently bills Medicare patients for a blood work series that was never performed. The physician has never been questioned about the fraudulent billing, but Marie is uncomfortable every time she charts the ghost procedure.

Read the case below and answer the questions.

1.) As the person who must continue to work with this physician, what should Marie do?

2.) Penalties for health care fraud can be severe, including loss of license to practice in health care, fines, and even prison time. Should Maria be concerned that the physician's fraud could affect her?

3.) Can the physician retaliate against Marie if she finds out Marie reported her?

Answer 1

1.Marie has to report it to the concerned department regarding the fraud. If she tries to hide or conceal this information, she can also be in trap when any legal issues arises .

It is not only the physician being legally sued but also the medical assistant also with the provider will be sued .

2.This could affect her career if found later by not reporting to the concerned authority or officials under tort of negligence or intent tort.

3.Marie cannot be retaliated by the physician if she abides with the law and does her work.