Personal Health Care Ethics

I was first introduced to the Health Care Field when I joined the Air Force. They taught us many things from taking care of a patient to the rights of the patients. Although I did not do billing at that time I was educated on the issue soon after I was discharged when I started working for a physician in private practice. From those experiences I have gained an ethical basis for what I feel is right and should be enforced and they are: patient rights, patient dignity, confidentiality, non-malfeasance, proper billing.

Patient Rights

Every patient has the right to make their own decisions about their health, health care providers and facilities. Many patients are not given many options for their health care needs, this is seen by the providers they are allowed to chose, the facilities in which they can have the services provided and the services the insurance company will allow. Since many people pay a high price for healthcare they should be able to choose their healthcare provider and have those services covered, yet they are forced to choose what is allowed by the insurance companies because they cannot afford to choose a provider out of network, or to pay for a service that is refused by the insurance company.

Patient Dignity

Every patient has a right to have their dignity intact when receiving services. I have seen instances where hospital employees will gawk at a female patient and make inappropriate comments when they are under anesthesia, I do not feel this is appropriate and have informed the individuals in charge of the issue.

Patient Confidentiality

Every patient has a right to confidentiality. The services being performed and the diagnosis and any other confidential information should be protected from anyone other than the patient or those that the patient deems necessary to speak with in regards to their health care issues and information. This is now handled through HIPAA regulations.

Non-Malfeasance

Every patient has a right to have no harm come to them while under the care of a physician or healthcare facility. It is very important to ensure the patient is comfortable and that all precautions have been taken to ensure they receive the best care possible.

Proper Billing

Every patient has the right to have the services that were provided to them billed to their insurance company within a timely manner as well as the proper allowances taken prior to billing statements being sent to them. It is very important to bill the insurance company for the services provided and in many cases there needs to be the proper documentation and authorizations obtained in order to complete this process. I have noted several occurrences where the insurance company was billed and authorizations were not obtained by the physicians' office and the bill was sent to the patient. This is not proper practice and it was reported to the physician. It turned out the physician did not realize this was occurring and could not understand why his patients were leaving him.

Over the years healthcare has changed with technological advances as well as changes in insurance coverage's. The ethics that most medical professionals follow have not changed, with the exception of the inception of HIPAA. It is the healthcare professionals that have changed. Many more people are involved with identity theft and are invading people's privacy. HIPAA has made it necessary for shredders to be used for all confidential information, which is going to make it harder for those unethical people to obtain such information. Sarbanes Oxley has now required many companies to formulate their procedures and processes to ensure that things like fraudulent billing cannot take place or is caught quickly.

In my last position, my Billing Supervisor went to a facility to train the employees on a new billing system; while she was there she observed several groups being performed, which is not out of the ordinary. However, what seemed odd to her is the groups consisted of 30 patients; she called me to ask a question and brought it up in casual conversation what she had observed. I could not believe what I was hearing; I immediately called the manager on site and asked if this was happening. He told me no. I called his superior and explained the situation and that manager immediately went to the facility and questioned many of the therapists and found out that the manager had lied. This type of therapy is not compliant and was being billed to Medicare. We had to supply a complete audit of our findings to Medicare after we informed them of the incident and had to reimburse them several hundreds of thousands of dollars. This also sent a red flag for this facilities billing which took three years to clear.

This action went against many of the ethics I hold valuable, patient rights, dignity, confidentiality, non-malfeasance, and proper billing, because they caused several patients to work beyond their capability which could have caused harm, many of those patients did not want to do their therapy in the company of others and the billing was definitely fraudulent.