Ethical Dilemmas

Ethical Dilemmas

Ethics can look easy on paper, but the working world offers some complex situations. In the April print issue writer Mark Crawford explores three scenarios that illustrate the kinds of difficult situations that HIM professionals can find themselves facing.

“Some behaviors are clearly unethical—fraud is an extreme example,” Crawford writes, “but many are less clear and occur in complex situations. The most complicated situations often involve colleagues who witness what is, or appears to be, unethical behavior and are unsure how to respond—especially if job security is on the line.”

The following scenario, reprinted from the story, is a good example. What do you think? What leads to situations like this, and what options does the coder have? Are HIM professionals in all roles (not just coders) facing greater pressures to commit or condone questionable or unethical behavior? Discuss it by commenting at the end of the scenario.

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Scenario 1: Pressure to Upcode

In a large, for-profit, multi-specialty clinic, strong emphasis is placed on optimizing revenue opportunities for private-payer patients. The coding supervisor, who holds RHIT and CCS credentials, has informed the coding staff they must consistently assign E&M codes at a higher level than documentation supports.

One of the coders, also CCS-credentialed, has expressed her concerns about the appropriateness of this direction. The supervisor has indicated these comments are unwelcome and implied the coder should perhaps seek employment elsewhere if she has concerns. However, this is the only healthcare facility within the community, and the coder is a single parent with financial responsibilities for her family.

“The ethical concern here is the coding supervisor’s pressure to increase revenue at the expense of actual documentation to support the codes assigned,” notes Dana C. McWay, RHIA, JD, a clerk of the United States Bankruptcy Court for the Eastern District of Missouri in St. Louis. “She clearly does not value the coding staff’s input, as evidenced by her comment that criticism is unwelcome and the implication of seeking another job.”

It seems clear the supervisor’s instructions are intentional and designed to increase financial gain for the clinic.

This, of course, puts the coder in a difficult situation, especially with the hint of termination. Any liability for incorrect coding will likely be assigned to the coder and the clinic.

If the supervisor’s instructions are carried out, the clinic risks “financial and reputational harm, possibly resulting in sanctions by external forces,” says McWay. “Damage is also done to individual coders who are asked to sacrifice correct coding standards to comply with this inappropriate request. There is also harm to AHIMA because both the supervisor and coder are credentialed and represent the association’s ethical standards.”

The scenario contains multiple violations of AHIMA’s code of ethics, especially principle II, which instructs members to conduct their work in an honorable way. The supervisor also is violating principle IV, which calls for refusal to participate in unethical practices or procedures. Guideline 4.6 has also been broken, which states HIM professionals will not perpetuate dishonesty, fraud, or deception.

Probable violations of AHIMA Standards of Ethical Coding include standards 1 and 3 (accurate coding practices) and standards 6, 9, and 11 (not committing fraudulent or unethical practices).

The choice the coder makes may depend on the corporate culture. Does the culture encourage the reporting of violations? Will the company protect the coder if she informs another supervisor about the situation?

“I’d suggest she seek advice from a trusted HIM professional, just to be sure the direction given is indeed inappropriate,” says McWay. “If so, she needs to learn what process is available for voicing her concern to a higher level. Some organizations have an ombudsman or similarly situated individual who can help in situations like this.”


  1. If the supervisor wants more money coming into the office then there needs to be a physician training program about how to code. Make sure there are external causes applied to the injuries and illnesses. Car accident, side impaction, front passenger seat and so on. The more in death the diagnosis is the easier it is for the coder to bill for that diagnosis and office visit.

    Diagnosis with a broken arm, that is all that is being coded. If you start adding in the in-depth how it happened, why it happened, you got to tell the story then the doctors can themselves upcode due to minutes spent with the patient.

    I will not take the downfall of a fraudulent act regardless if I get fired or not. As a Medical Coder, I have to do what is right because two wrongs don’t make it right.

  2. The coder should report the supervisor because she is not following the code of ethics. She is asking the worker to commit fraud this could cause her to lose her job,license,and possible jail time.

  3. The coder may be in danger of losing her job,as a single parent its unsure to trust anyone in the office I think she should contact an higher authority.Someone in HIM.

  4. Receiving direct instruction to commit an act of fraud is always ethically wrong I would compile records to support the supervisor’s directions given and report to another supervisor or HR. Ultimately, the coder would be responsible for the fraudulent billing and your reputation is not worth the consequences.

  5. If someone is pressuring you at work to do the wrong thing, then chances are that doing the wrong thing will cost you much more than your job. In the medical field that no only means loosing your job, your integrity,possible legal fines, possible imprisonment, and the ability to ever work in this field again. Let’s also consider the time, effort, money, and stress of getting you education and training to work in the field. Loosing all of that would impact your ability to care for your family now and in the future. The personal cost far outweighs any other obligation to a supervisor and does not justify going along with this behavior to keep the job. I would first report the documented conversation to the compliance officer and if it wasn’t resolved then find another job. I know it’s easier said than done, but ethical behavior is always the right choice.

  6. The coder should stay with what the ethics say. Instaed of being influenced by the supervisor.

  7. Ethics in coding are very important. If your supervisor won’t listen to you then you need to go to their supervisor.

  8. It is the coders responsibility to uphold the code of ethics standard established and maintained by the AHIMA during all circumstances and in any setting. I would suggest that she express her concerns to another supervisor or coder at the clinic. If the other supervisor/coders feel that this is common practice then her next step would be to contact a representative from the AHIMA. The representative will be able to help her determine if the orders given by the staff supervisor are ethical. The coder obviously knows that she is obligated to always be honest when coding. Her job might be in jeopardy for not agreeing to commit unethical practices but she must remember that her certification will be in jeopardy if does something unethical.

  9. The coder has a ethical obligation to follow guide lines. If the supervisor doesn’t agree then there should be another supervisor they can talk to

  10. Its So unfortunate that this individual has to be put in this situation. Its clear that the supervisor has no regards for other citizens ,and is in for his own gain. Clearly would seek other employment after notifying the superior in this situation.

  11. I agree with the comments provided above. The coder should gather as much information as possible that proves what her supervisor is instructing is unethical. She should go to her supervisor’s management and present the information informing them that if this continues not only could she be punished as the coder but there could be major repercussions for the clinic as well.

  12. I agree with many of your comments. The coder should gather all the necessary documentation that proves the practices are unethical. She could contact someone above her supervisor and express her concern for both herself and the clinic. Advi

  13. I think this coder is in a very sticky situation. Obviously she knows what is right, but her supervisor is making her job hard. I feel the supervisor should value her worker and have some empathy.I hope the coder would seek help from HR, but I know sometimes in facilities like the one mentioned, the community sticks together. To many politics in the works place. I personally would try to work else where, but in this situation, a bad reference may make it hard to go elsewhere. Whenever a person transfer jobs, you are asked why you left your last job. If you are honest it can come back to haunt you especially when these facilities compete. I in my past have had an employer tell me I was not allowed to quit or they would make my life harder if I went anywhere else.

  14. It would appear that the supervisor is breaking some basic rules and guidelines. The difficult part is how to manipulate around the situation so that it does not impact the person’s job. Ideally the company should have a complaint/compliance person but if not the best thing would be to talk to human resource. There should be at least three people and document, document and document.

  15. There are some very legal ramifications in this scenario that go even beyond the ethical dilemma. Obviously, the supervisor is aware of the coder’s situation, and knows that they can’t just walk out. I would also have to wonder if the supervisor isn’t close to violating employment laws – there is basically a threat of unemployment if the coder refuses to go along with something they know is wrong. Does AHIMA have some resources for the coder? Also, this supervisor must have a supervisor who understands the risk that the facility is being made vulnerable to. If this is the belief of the healthcare facility, then the coder would be better off to not work there since they are putting themselves at risk also. Since this coder has some experience, it may even be possible to do something remotely from home.

  16. It is unfortunate that there are supervisors who put their employees in a position where they have to choose to go against ethics or risk losing their jobs. Hopefully, most organizations have a compliance department where these types of things can be reported and protect employees who report these situations, to prevent this kind of unethical behavior.

  17. The coder should talk to her supervisor about the situations so they can work something out.

  18. This is very sad but probably more common than one wants to admit. This individual is an precarious spot. As it is the supervisor who is pushing for this I would wonder if this attitude is pervasive throughout the company. Therefore, I would want documentation of some sort before going to another individual about my concerns. After attempting to gather a record of my concerns I would approach the next level supervisor or the utilization management department. I may even phrase it as a question- Why am I billing this way. It is possible (though unlikely) the employee misunderstood the standards required for billing a particular way. Since it is hard to tell how high this goes, it would be ideal to have some documentation to back up the employee’s statements. Thus if she is challenged and fired she has some way to protect herself. By documenting both her reasons and her actions the employee can better protect herself should an investigation into her coding take place but it is essential that she take action.

  19. The supervisor is in the wrong and the coder should document the incident and bring it to HR. No one should be threatened to lose their job because they won’t do what it wrong or unethical.

  20. I can’t believe there are situations like this out there! For her supervisor to put her in that situation is terrible. She needs to contact someone from HR because fraud is being committed because that is what I would do. I would not want everything to fall on me if it’s discovered what is happening because the supervisor could act like they had no idea this was going on.

  21. Ethics should not only be for the company but should be personal too. I think if you comprise your your ethics you are not only hurting yourself but the company in which if work for. If this boss is telling you to “bend” the rules to get the company more money than they clearly need to take a look at their personal ethics. No employee should feel they will be fired for doing the right thing. I would go to HR and let them know what is happening so they can look into the situation and investigate who they have put in charge. They need a leader who inspires them to follow the many coding laws and make it not about money but about patient care.

  22. I cannot believe that a supervisor would think so little of her employees. Ethics are a huge part of the coding world, maybe the supervisor needs to find employment elsewhere

  23. Besides being unethical, this is fraud. I can’t imagine any facility wants to be investigated for fraud. The supervisor is way off base to request coders to do the up-coding. It is sad that the employee has to be intimidated into thinking she will lose her job if she keeps questioning the supervisor. I think the employee should go to the compliance department (if they have one) and show them her evidence. If there is no compliance department then maybe she should try someone in a high position within HR. Nobody should be pressured to do something they consider unethical or that they know is wrong just to keep their job. I would bet if that coder was brought up under investigation for the up-coding, her supervisor would not back her up and would let her take the fall.

  24. The worker definately doesn’t want to put themselves in situations that put them in a liability. I know at my work we have a toll free number we can call if we have ooncerns so if they have a number to call anonymously then they should do that. Either way they can’t code incorrectly for the gain of the company because the coder will get in trouble not the company.

  25. The supervisor’s attitude and behavior are completely inappropriate and unethical. The supervisor is risking serious legal consequences for the medical facility, as well as serious harm to their reputation. The supervisor should be fired, not the coder. No supervisor should ever put an employee in the same position the coder was put in. All medical facilities should have policies in place to prevent this from occurring. There should be someone at the facility that the coder could report the supervisor to without fear of losing her job.

  26. Many companies have an “open door policy” when it comes to raising issues or making a complaint about a co-worker or supervisor. The policy states that an employee who makes a complaint in good faith can not be retaliated against (including harassment and employment termination). I would hope that the organization where this coder works has the same or a similar policy so that she will not have to choose between compromising the integrity of her work and possibly losing her job. There needs to be protection for any individual that raises ethical issues to upper management and HR. If that protection is in place, it should help to deter these unethical practices from arising in the first place.

  27. Many emotions are involved with ethics, that is why sometimes it isn’t always a black and white situation.
    If this is a large facility their must be other coders feeling the same way. First, the coder needs to make sure that other coders realize that this is an ethical issue; and they are also at jeopardy with their jobs.
    Approaching the HR department with the backing of the department, will make more of a difference if everyone realizes it is wrong.

    Forcing the supervisor to re-evaluate her earlier statement.

  28. The true measure of a person’s character is doing what is right when no one is watching. Unethical behavior is wrong. The overcharges could cause the clinic to be charged with fraud especially since it is deliberate. I do not envy the coder as it is always hard to stand up to your superiors and no one wants to feel their job is in jeopardy especially when they want to do what is right. I wouldn’t want to be the patient who is being overcharged either. Unfortunately the coder does have to take a stand on this issue.

  29. Ethics do seem easy on paper but then when real life and real people are involved that is when the situation’s get complicated. As these example’s prove there needs to be some governance of these and other ethically questionable situations to keep people honest.

  30. As a coder this would be a tough situation to be in, but coders need to follow their code of ethics. This supervisor asking these coders to up code should be fired, HR needs to step in and resolve the situation by terminating the supervisor. It’s wrong to ask this of the coders and it’s wrong to gain a financial benefit also.

  31. This situation is obviously for financial gain. This not only violates the code of ethics, but its also fraud. These kind situations are what give the healthcare industry a bad name and also icreases insurance rates. This needs to be brought up to the HR or other superior or go as far as the state or federal level.

  32. I dont think any employee should have to feel they will lose their job if they dont do something unethical and every business should have a policy intact to prevent this from happening.

  33. Ethical behavior is something that needs to be practiced everyday. Situations always arise that contradicts with what we know to be right, such as these scenarios, and we have to know how to deal with them productively. The code of ethics in the workplace should be reviewed frequently so that each staff member has these fresh in their mind. A strong code of ethics should also be practiced everyday outside of the workplace so that there is no question or doubt in our mind to make the right decision when there are conflicts.

  34. I am currently a student AHIMA member. I am taking the course to complete my HIT degree to become a RHIT. I feel very strongly that this employee definitly needs to seek out a higher person above her supervisor. This is very incorrect for a supervisor to be advising her employees to upcode and code incorrectly. This is such a sticky place to be in within your employer. She definitly needs to think not only is the clinic she work for at stake but also her certification and her career.

  35. This is very sad that a person in a leadership role would be exhibiting this kind of behavior. I would hope that the coder would feel safe enough to report this to someone higher up than her supervisor so it could be dealt with appropriately.

  36. This is an unfortunate circumstance the coder has been put into. She is fearful of losing her job by following her supervisors instructions as well as doing something she knows is unethical and against the law. The coder is credentialed and knows the violations of AHIMA’s code of ethics. If she were to go along with her supervisor and get caught, she would be fired and lose her job regardless. Documintation of the supervisor’s comments and instructions need to be taken to management or whatever the clinic’s protocol may be for ethical violations and dealt with professionally to preserve her credentials and job with the clinic.

  37. All three situations were interesting. For the upcoding issue she definitely needs to bring this issue to HR or the compliance officer because either way she looks at it if she doesn’t report it she is in a bad situation. If she doesn’t upcode she will get in trouble by her supervisor and fired, even though she doesn’t deserve it. If she does upcode and it was audited she would get into even bigger trouble and I doubt her supervisor would stick up for her. Personally I’m sure her colleagues feel the same way about the situation and they should discuss it and bring it to HR or the compliance officer all together because they would have a stronger case then.

  38. In addition to violating the AHIMA code of ethics, the action of up-coding, were it to be performed, is fraud. The clinic could be heavily penalized for performing fraudulent billing practices.

    Hopefully every organization has a process in place to enable anonymous reporting of such unethical procedures. In this scenario, the coder is in a very tough spot due to her personal situation, ‘other’ job availability, etc.

  39. The supervisor obviously overstepped her bounds by demanding the coders code without documentation. Perhaps this is a situation where it would be justified by going over the supervisors head, and reporting this situation.

  40. I don’t believe that ethical violations can be placed on a scale from “less wrong” to “more wrong”. An ethics violation is wrong but the reasons for the violation might be motivated by good intentions or ignorance or fear. If forced to state whether a situation of ethics violation is “more wrong” than another violation, I would perhaps look at the number of ethical standards broken and the potential consequences of the violations.

  41. The coder should document all known ethical violations and go above her supervisor with the documentation. Like Dana McWay mentioned in the article, consulting with a professional for advice would be a good idea.

  42. The coder should contact compliance or HR regarding her concerns. These are very serious issues that should be addressed in a timely manner

  43. Without sounding like I would do the wrong thing (because more than likely in this situation, unless it meant life or death to my children, I would do what was right…. morally and ethically), I see where this could be a hard decision. I think I would go outside the company, to a Government agency to make my claim.

    I think it bothers me even more that they would upcode the private pay clients vs the ones that have insurance. Being from a family that if it wasn’t for assistance, my kids wouldn’t have insurance since I am a student, and I am in the same situation as the person described above, I do sympathize with her situation. I would probably look into moving to a place where I had a better chance to survive. Whether the FEDS shut the place down, or she loses her job for doing the right thing, the end result seems to be that she will be jobless, unfortunately.

  44. This is a truly unfortunate situation for the coder who is following her ethical principles by raising her concerns with her supervisor. The supervisor is quite clearly directing the coders to code in a highly unethical, even fraudulent, way in order to increase reimbursement. The response to the concerns raised (i.e., that the coder raising the concerns should seek other employment) only reinforce the fact that the upcoding being done is intentional and not due to lack of knowledge.

    My first instinct would be to advise seeking another job as quickly as possible, as the culture at this clinic seems to be severely lacking in ethical behavior and practices. However, as the only healthcare facility within the community, options for this coder are limited. I would advise contacting administration at the clinic, since voicing her concerns to her direct supervisor did not change anything. It should be emphasized to the administration that this type of unethical behavior (upcoding) can have serious ramifications for the entire organization, financial and otherwise.

  45. Like others, I wondered if, in the facility where I work, these “ethical dilemmas” would be an issue. I’m guessing now that they are. One would have to gather the evidence to support what one is saying is fact, as I’m guessing there could/would be repercussions either way, and take it to a higher authority in the company.

  46. I think if this was a real world situation and you know your supervisor is doing something unethical, you should go to HR to report what is going on. But you need to have some strong evidence to back up what you are saying because accusing people of being unethical is serious.

  47. If an employee is uneasy about an unethical situation they should bring this to the attention of their administration or the OIG. Recently in my hometown there is an ongoing story very similar to scenario one. An employee was terminated because he went to his administrative board and told them that two of the doctors were falsifying their documentation and were overcharging for some procedures that never occurred. There is now an ongoing investigation against the doctors and the hospital for Medicare and Medicaid fraud.

  48. I know that sometimes people get behind on their workload but even so, they still have an obligation to be ethical and do the right thing. If your supervisor promotes unethical decision making and doesn’t allow you the opportunities to continue your education, then it should be addressed with a higher authority. People like that should not be in those positions since it’s obvious they can’t handle doing what’s right for both the employees and the organization.

  49. Being fairly new to the healthcare field, I was unsure about how common each of these three situations were. After speaking with a few of my coworkers and discussing each scenario in detail and how it pertained to our positions, how it could affect our department, and our patients, I now understand how big of an impact these ethical dilemmas have on the healthcare field. Not only that, but my eyes were opened to how very common these dilemmas are, making me feel much more prepared for when one of these issues (or something similar) will surely cross my path.

  50. The coder should gather all information and any documentation on the unethical practices that she is being asked to perform and take them to HR or a compliance representative. She may be able to find someone she trusts in the same department feeling the same pressure to perform unethically and they can both go to HR or a compliance representative with information and documentation to help each other out and hopefully get the manager replaced with someone who will act professionally and ethically. She could also report her findings to AHIMA. If the manager is a credentialed member, I’m sure they would want to know that one of their members was acting unethically.

  51. In this situation, the supervisor is advising coders to commit fraud to optimized revenue. Obviously, the coder wants to act ethically which also places her job on the line. I’m sure the company has rules and regulations about reporting cases like this. The coder should figure out what steps to take, because she could be liable for the incorrect coding.

  52. I am sure circumstances like this probably happen more than what we realize. I think with all the pressure put on HIM departments to be profitable and keep everything in line, that some people think it is okay to fudge some things or do unethical things to continue to make themselves look good. I think the solution to alot of these problems should start at the top and work down. Management needs to set the precedence when a manager is hired and make sure they know that they expect an honest and ethical work environment and to make sure that it is passed on to all employees as well. They should be proud of their employees’ credentials and the hard work they put in to achieve them and they should help them to continue their education so they can perform their job to the best of their ability. They should make it clear that at no time is it okay to be dishonest or unethical in your job and they should encourage employees to report any behavior that makes them feel uncomfortable without fearing that there will be retaliation if they do. If you set the example high right from the management down to the employees, they will feel good about doing their job and will work hard to set a high level of work ethic.

  53. I think that these situations arise from an organization that has been operating in unethical ways for a long period of time, possibly from the organizations start. It stems from cutting corners to meet the bottom line and from being, frankly, dishonest. I feel bad for employees who are pressured by their supervisors to be unethical or lose their job. Perhaps with the predicted job shortage in the HIM field in the near future, we can be more selective about where we work and organizations that do not follow the code of ethics may not be allowed to survive if they do not adhere.

  54. As a current HIT student, it’s good to be learn about all aspects of the field, including the negative in order to truly get a grip on how things sometimes may play out in the real world. It’s always good to be prepared for the good, and the bad of a job, and to understand the ways in which to help solve such issues that may arise at some point, although hopefully not.

  55. In a situation where a boss is seeking to leverage employees by forcing them to risk their own financial safety and employ-ability, outside help is necessary. It would not be the first time that a position of authority was abused to force unethical behavior in the name of profit. The idea that it should be enforced through a supervisor in a passive aggressive manor seems in line with the ethics of the attitude being presented. I believe that no matter what direction you take the position or job you have has been altered and cannot easily be fixed by you as an individual. I would seek outside opinion of my company and department as well as professional peer advice on how to move forward before working on the situation internally.

    1. Yes,I Agree the Medicaid ethical information coding financial serious organization individual is labeled.

  56. I think the coder showed had spoken with HR department of the compliance office to see if thiss issue could be resolve. I think the coder should also provide any documents to support the complaint. This a dishonest and diffcult situation to be especailly when one has been threatend on the job.

  57. In the cases of unethical behavior portrayed in this article, anyone asked to participate in these activities would be best served by precise documentation of requests for fraudulent activity. This documentation could then be presented to the most immediate supervisor, and additionally a representative from HR. Specific facts as to date, time, and precise wording will keep emotions at bay when presenting concerns of unethical behavior, even while inside you may be shaking. In the end, the organization, as well as any professional credentials of the coders and supervisor, and reputation as a whole are at risk should unethical behavior be allowed.

  58. All three scenarios are possible in the HIM environment. Ethical behavior trumps bullying behavior every time. The important thing for the individuals faced with these dilemmas is you are not alone. Immediate supervisors, as well as Human Resources representatives, and a fantastic organization like AHIMA with their standards of practice and ethics, will help these individuals through intense situations affecting their daily work.

  59. This is an excellent example of an unethical situation that a HIM professional may encounter on the job. As a HIM professional, we are obligated to uphold the high quality and ethical standards of AHIMA. The coder should document her conversation with her supervisor, and also address her concern with her fellow coders. It is possible there are other coders with the same concerns. I would then report the incident to the compliance officer, or possibly the supervisor’s manager. I may also seek the advice of AHIMA. This type of unethical behavior is harming the organization’s reputation as well as AHIMA’s.

  60. These were some interesting scenarios especially the coding one. What a horrible position to be put into, but at the end of the day it comes down to taking a stand and doing what is right.

  61. In this circumstance, I believe the coder should meet with her HR department or the compliance officer to resolve this issue. One should never feel pressured to be unethical and dishonest in the work place, especially when you are dealing with fraud and threatened with losing your job. The coding superviser should be reprimanded or possibly dismissed for liability reasons.

  62. All three of these situations can happen in any facility. Employees should feel like they can act ethically in their day to day job. Since these are all credentialed employees, they need to do what is ethical and no matter what happens, they should feel good that they did what was ethical.

  63. All three of these situations have a very real possibility of happening and it is important that there is a culture of doing the right thing in these facilities. The feeling that it is safe and necessary to do the right thing without jeopardy or consequences is crucial.

  64. In an age of economic uncertainty, downsizing, and the enormity of healthcare costs, I am not surprised that scenerios like this are playing out. In this particular case, the risk of committing a fraudulent act or at the least not reporting it is a greater detriment to the coder, the facility, and the healthcare system in general than doing the right thing by following the code of ethical standards and coding properly. If I were to put myself in this coder’s shoes, I would gather all evidence and documentation of the supervisor’s instructions and any fraudulent actions that have taken place. I would find someone in a position of authority at the facility that I could trust and report these findings. If the facility is smaller and does not have a compliance officer or a trusty human resources system, I would report this to AHIMA. Either way the coder is put in an unfair situation, and while she may risk losing her job with a child to support, if she says nothing she will still risk her job and reputation and will damage others in the process. As a credentialed coder she has an obligation to fulfill.

  65. I think the coder has an obligation to herself and her organization to report the situation, but first she needs to gather any evidence she has witnessed her supervisor conduct. She then needs to do her research on the current code of ethics and what is expected of her and her supervisor being that they are both CCS-credentialed. Then I would suggest bringing this information to a higher-up than her supervisor. If no action is taken then she needs to keep climbing the ladder until the problem is resolved. The coder can than hold her head high knowing she made an ethical decision to better her department.

    1. Hello I have a scenario that I need help of. If the RHIT is confused of the situation, what is the best thing she can do? For example, a certain doctor calls the HIT department and requesting for the past history of the patient coz this patient has a progression of epilepsy and then the patient can;t provide information about drug allergies. Then the RHIT, pulls out the records but notices that the record is sealed file because of a pending lawsuit. So she closes the records and confused how to deal with the situation. My question is, how will the RHIT deal with the situation? Please help me so I can have ideas. Thank you very much

  66. This is a very difficult situation to be placed in, especially considering that her supervisor threatened her job. However, she should still go and speak with her HR or compliance representative directly. She could try to discuss the situation with her supervisor, but with the feedback she previously recieved I doubt she would have much luck. Once she reports it the issue will no longer be on her shoulders.

  67. All three scenarios are really good in showing what can happen in any areas of work. All three people need to know that they should be able to come forward let someone know that mistakes are being made. The mistakes can be be corrected in a timely manner.

  68. This is a very difficult situation to be in. She must go with her gut and it seems to me it is telling her to take action. She needs to go to the coding supervisor’s supervisor. If she does not find resolution there, she must keep reporting this up the ladder until a resolution is found. The most important thing here is for her not to give up. They may be threatening her job if she does not comply, but if she goes along with it the damage to her reputation as a coder once found out will be much worse.

  69. Doing the right thing is the most important for your reputation and the reputation of every person who is credentialed to maintain the professional status of this field. In any of the scenarios, it would be important to bring your concerns to a compliance officer or HR or whoever in the organization is in charge of such things once you have tried talking with the supervisor first. Unethical practices don’t help the reputation of the facility either, which should be a concern and help with resolution of the situation. Contacting AHIMA may also help.

  70. All three scenario’s had some tough decisions that need to be made about the ethics and the standards that we follow when we are members of the AHIMA. As members we do not practice unethically or unprofessionally, there are employers that will follow those standards and it may not be the easiest but those are the employers that we should work for and be proud of what we do everyday. These behaviors should be reported without worry about employment.

  71. I hard to believe there are people out there that would think something like this is ok. She does need to gather all the evidence she has and go above her supervisor. The only problem with that is there is a chance she could get fired or management above her could be the ones informer her do this. In the end it all comes down to doing what is right and not necessarily what is easier.

  72. As a current student in Health Information Technology and a transcriptionist of quite a few years, it’s become clear to me that health information technicians need to think of many things as hard and fast rules (not just guidelines) and also need to refer to the rules of their employing organization and the organizations and legal entities above their organization on a regular (daily at least) basis. Being less than clear can lead to ethical problems, not to mention problems for the patient (always a very high priority for all of us).

  73. All three scenarios were interesting examples where uncomfortable decisions need to be made. Ultimately, it all boils down to doing what is right instead of what is wrong. Ethical behavior is a must, no matter how tempting it is do otherwise. An employee’s fear of retaliation for not following orders is understandable, however, if indeed unethical behaviors are being carried out within an organization they should be reported immediately to the compliance officer, or anyone else in upper management that can bring improper business practices to an end.

  74. I think that the coder should consult with an HR supervisor, or contact someone that can help with this situation. The coding supervisor should be talked to since there is a threat to the clinics reputation, and since it is against AHIMA.

  75. These are all very difficult situations and it is disturbing to believe this happens, but the reality is, it does. I think the coder needs to talk directly to her supervisor. If she is still unwilling to assist, she needs to go higher up, or contact the Compliance Department directly.

  76. I feel that the coder should gather information supporting her claims of the upcoding and report them to the compliance officer or HR. I don’t understand how someone in that position could be so unethical.

  77. I think that individual should figure out who to discuss this with at higher level than her supervisor. Then gather up evidence to present. It may also be smart to give that person a list of names if they don’t already have that information so that there may be further investigation done about the problem.

  78. I feel that this is a serious issue and that the coder should gather her information and talk to another supervisor or upper management. I can’t believe that someone would actually ask a coder do something that is so against the ethics in coding.

  79. The coder should report her concerns to another supervisor that she trusts, the Director of Compliance or the HR Director. If you are employed by a medical facility you are required to report even suspicious non-compliant acts to a person in charge. If she does not she is putting the facility in jeopardy just as badly as the coding supervisor is.

  80. The coder should follow AHIMA standards for ethical coding.No one in this position should feel pressured to do something they know is unethical. The coder should discuss the situation with someone in the department and come up with a solution that will prevent the coder, the supervisor and perhaps the whole clinic from getting into trouble.

  81. I think the employee should verify the information is correct, that she was instructed to upcode and then discuss it with the compliance officer and if nothing is resolved then she should report it to AHIMA also.

  82. I beleive that you should feel comfortable at the work place and if you are asked to do something unethical you should not go against your beliefs. If you follow the proper procedures and still things are not run correctly then that would not be the place I would not want to work for and would seek something else.

  83. I think it is wrong for the coding supervisor to not only make these coders document things that are not true, but also to hint at, if it is not done then they may lose their job. I also think that the coder should go to their HR manager and report what their supervisor is asking them to do. I don’t think that people should be afraid to speak up when somebody is asking them to do something that is not right, because if the coder goes along with this, eventually it will be found out and they will end of losing their job in the end.

  84. This is a great article for classroom discussion.

  85. Pressure,fustration and fear, constant change and large volumes to keep up can be overtaxing. The outcome of each scenario has severe consequences fraud, loosing accrediation and fustration and other negative feelings or outcomes from the employees .

    scenario one, contact Ahima member or complaince officer to find out the options. Scenario two, I would report it and incorporate a backup plan or person to check the numbers. Scenario, three check with HR to find out possible option or suggest a plan .

  86. It’s not always easy to do the right thing. If that little voice inside is saying “there’s something wrong here,” there probably is something wrong. I would definitely go to compliance or HR with this issue as others have suggested.

    1. I agree, most of usually have a gut feeling when something is correct!

      Alwaytrust your initial feelings.

      Report the problem and if nothing is done get out of that place quickly.

  87. Scenarios like these usually happen because one or more people within an organization are trying to either avoid consequences for existing problems, or they are wrongfully trying to increase profits, or are just plain selfish and uncaring about the quality of their department and or organization. No matter how small some situations may seem, each wrong action grows into a much larger problem down the line. If these types of scenarios are handled in the wrong way, it not only reflects badly on the individual but also on the organization and any others associated with them. Once an organization or individual is labeled with the stigma of being unethical, it is like a scar that is there forever, that person and organization will be “questionable” in the minds of fellow professionals.
    To resolve and prevent these situations now and in the future is to do the “right” thing, turn them over to the correct individuals, and tell the truth. If there is a history within an organization of strict ethical behavior and support for doing what should be done, than that will lay the brickwork for preventing and dealing with these issues as they arise.

  88. Many situations can lead to ethical compromise. Usually when people deliberately choose what they know to be wrong, they do so because they rationalize that the benefit of their choice will far outweigh that of doing what is ethical. In any event, It is imperative that people understand that there should be no flexibility in ethical situations. Being dishonest, misleading, and/or disrespectful is incorrect universally, regardless of the outcome. It is possible that people may make unethical choices if they feel threatened by the ethical outcome or are insecure about the situation. It would be important for any company to foster very clear ethical policy and underscore that policy with regular compliance initiatives. Employees should be required to complete refresher ethic compliance training; even if that means simply re-reading the policy and signing an acknowledgement annually. Upper management needs to make a commitment to voicing this priority to management and supervisors. To ensure that their first obligation is to their code of ethics in their business practices. Everything else is subordinate to this framework and without it, your business is unstable. If managers feel confident in portraying a culture of honesty and integrity and can feel certain that it is the first priority of their company, it may reduce the dilemma that some employees are faced with in these situations.

  89. I feel that all of these situations are very tough places to be in. When it comes down to it, you always have to do what you feel is right.

    1. I agree, doing the right thing is not always easy, but it is the only course of action.

  90. All three are excellent learning scenerios. I would have to say that the coder should speak with HR (or compliance officer)- which ever is the case; especially if it’s her immediate supervisor who is instructing her to act unethically.

  91. The coder should speak to the compliance officer, as Nancy has suggested, but should have all relevant documentations to support her claim of upcoding. Another way for coders to protect themselves from incidents as these, is make daily notations of any unethical behavior they might observe.

  92. All three examples were interesting. As a current Medical Coding student information such as this article is very valuable.

  93. The coder should gather her research and information that supports her position and then discuss the issue with the compliance officer or HR. I believe compliance would take this very seriously due to the potential for repercussions.

    1. I too believe the supervisor is wrong in asking the coder to compromise her ethics! The coder should collect all her information together maybe even see if anyone else has been asked to do this, and confront HR with their concerns. If we start compromising our ethic, what code of honor do we have to live by!

    2. I would make sure I had written proof and either go to HR or compliance officer or find a new, or maybe both!

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