You are a health information manager in a financially troubled acute care hospital responsible for coding functions. The hospital’s administration has retained an independent consultant who has promised to increase the hospital’s financial reimbursement under Medicare. The consultant recommends that your staff be more aggressive in applying diagnostic codes in order to elevate reimbursement. Furthermore, the consultant shares with you the methods that can be used to avoid detection of the aggressive coding scheme. You believe this more aggressive approach is, at minimum, inappropriate—and at worst, illegal. You have further learned that the consultant’s fee is based in large measure on a percentage of the hospital’s increased reimbursement under Medicare. Identify the ethical challenge and discuss how you would handle this situation.
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