Question

For your Unit 4 assignment, consider this example scenario:

Debbie Smith is a Medicare patient that presents to your facility today for a complicated expensive medical procedure that is not covered by Medicare. Your facility had prior knowledge of the non-coverage of this procedure and demands full payment from Debbie when she presents at the admissions department. Upon finding out that Medicare does not cover this procedure Debbie is upset and angrily informs the Director of Admissions that she will be filing a complaint because nobody informed her of the non-coverage. You are the Assistant Compliance Manager and you are responsible for addressing Debbie's complaint. Upon investigating Debbie's claim of non-notification you find that indeed she was provided no notification of non-coverage. You now need to determine what risk your organization has and determine what your next steps should be to ensure that this never happens again.

For this assignment develop an assessment of what risks your organization now faces if Debbie files a complaint. Define what penalties might be imposed if her claims are supported.

Answer 1

If Debbie files a complaint the company's image will be in danger that is it's impact can ruin the life of the organisation.

The company will have to incurr huge penalty which will be too much cost bearing for the company .

Customer will stop preferrng that organisation and overall market share may also fall .

Basically penalties for right claim can be either criminal or civil . Even the employee can be sentenced for jail and will be charged huge fines . The penalties will be according to the damages suffered by the customer .

Being Assistant Compliance Manager I would pay back the extra amount to the customer and would apologise to make things better .