Fundamentals of Law for Health Informatics and Information Management

Review your textbook “Fundamentals of Law for Health Informatics and Information Management”: pages 17-22 and pages 438-441 then read the scenario and answer the two questions below. Each question should be answered in at least two paragraphs. Be sure to support your reasoning by referencing the material you read. 

SCENARIO

Dr. Tony Smith is a kind-hearted general practice physician who operates a small clinic in a lower income rural area along with a medical assistant who primarily manages the front desk and office administration. Dr. Smith understands the importance of annual health exams as an effective and cost-efficient way to prevent or minimize future health problems, but many of his patients are not covered for annual exams by their health insurance plans. To solve this problem, Dr. Smith routinely has his medical assistant bill for services that he knows are covered by insurance, even though it is not the reason for the patient encounter. In addition, whenever Dr. Smith receives an overpayment from insurance companies or Medicare, he always is sure to donate 100% of that extra money to a charity that helps the poor and needy. As the medical assistant who tracks and handles these transactions, you are concerned that these practices may jeopardize the practice and your job.

Questions: 

1. Assuming his motives and actions are all done in good faith with the sincere intent of helping others, and assuming that he is actually saving the healthcare system money in the long-run by his strong preventative care strategy, do you believe Dr. Smith is necessarily doing anything wrong by altering the billing claims slightly so that his patients get the comprehensive and preventative medical care they need?

2. Do you believe that Dr. Smith is doing a good thing or a bad thing by donating all overpayments to the poor and needy? Thoroughly explain your answers, from both a legal and ethical perspective, including all the reasons that you believe support your position, being sure to cite/reference any applicable examples and/or support from the textbook or other relevant resources (e.g., “According to the AHIMA Code of Ethics…”).