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Please view the following presentation before you begin (attached). Scenario A hotline call was received regarding a potential coding and billing concern. Specifically, the caller is concerned there might be a pattern of billing Medicare for medically unnecessary cardiac procedures. – A physician is referring patients to a cardiology clinic for lucrative but medically unnecessary procedures. – The clinic is receiving payments above for these services in exchange for referrals of patients back to the physician. Put yourself in those boots….proceed as though the allegations are substantiated. Initial Post – Prepare a 2-3 paragraph summary and recommendation of your investigation and post it to this discussion. What potential law(s) from this week’s module are being violated here? Who: Provide hypothetical answers to the triage considerations referenced in this presentation and identify the departments you would include on your investigation team. How: Describe how you would report your findings and to what audiences? Be specific in your methods, frequency and approach. Include both internal and external audiences. What happens next? Rubric: Initial Post – The post is comprehensive and fully answers the discussion prompt. Student used complete sentences, appropriate tone, and clear language. Connection to course material – Strong, direct connections are made to the course readings and materials. Contributions are based on data/evidence, accuracy, precision, relevance and completeness (I CAN SEND YOU COURSE MATERIAL).


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