Ethical Health Care Scenarios

Scenario 1

Upcoding occurs when a provider uses CPT codes to bill a health insurance payer for providing a higher-paying service than was performed (Torrey, 2014). Upcoding is not only unethical but it is also illegal. Knowing your supervisor is very focused on the greatest reimbursement to satisfy revenue projections for the physician practice and place a lot of pressure on medical coders. The medical coders may fear the loss of their jobs if they do not meet the standards set by their supervisor; which could lead them to manipulate or falsify documentation to ensure they are meeting those standards. There are serious consequences to upcoding which include: legal troubles, the practice may be put in a position where they are forced to close down and the physician may lose their license. Upcoding also has a negative effect on the patient as well. Upcoding puts false information on patient medical records, and can affect their future ability to get insurance.

Scenario 2

There are many reasons why a clinician may choose to not report an incident where a medical error has occurred. I think the main reason a new graduate nurse clinician may choose not to report that she has made a medical error is because she may fear being reprimanded and possibly being terminated for her mistake. I read an interesting article that stated over 400,000 preventable deaths occur each year as a result of medical errors (Muha, 2014). The article went on to say that in nearly 9 out of 10 cases, another healthcare professional is aware that a medical error is occurring but they choose to remain quite (Muha, 2014). I found this number to be very shocking and really started to question why nurses would choose to keep quite knowing they could possible prevent a death from speaking up. The article brought up an interesting point stating that most nurses believe the physician performing the procedures is “untouchable.”