HIM M 108 Introduction To Health Information Management

Table of Contents


Care One is a well-known practice that provides medical services to rural communities that do not have their own hospital.

Patients must be admitted to the nearest hospital, which is located 30 miles away.

People consider Dr. Caremore to be the best doctor in the area. He is well-respected, well-loved and highly respected.

Dr. Caremore learned that he sometimes has to exaggerate the condition of a patient in order to get them admitted to a nearby hospital. He often has his staff call 911 to transport patients from his office to the nearest hospital.

The nursing staff has been told by him that he does this in order to make patients look sicker than they actually are.

Dr. Caremore understands that sometimes the patient’s family needs to take a break from caring for him or her. A few days at the hospital can often be a great help to them.

He doesn’t want them to have the responsibility of driving 30 miles to the hospital in order to be sent home.

The practice’s office manager is you. A member of the nursing staff visits and reports on the situation.

What are you doing?

This is a problem?

Dr. Pearson was recently hired by the Central City Internal Medicine Group to be its fifth doctor.

He is excited to start private practice after completing his residency.

Meredith and Dawn are introduced to Dr. Pearson by Meredith, who is part of the billing team for the practice.

Meredith is a financial support for the practice, unbeknownst of Dr. Pearson.

Meredith bills the procedures using individual codes and not comprehensive codes. She has decided to bill Dr. Pearsons services with Dr. Craig’s Medicare number (another Central City doctor) until Dr. Pearsons credentialing process is complete. If she isn’t certain if it has been submitted, she routinely submits more than one claim.

Name the frauds Meredith is engaging in.

These activities could Meredith be held responsible?

Does Dr. Pearson have to be held liable even though he does not know that Meredith is engaging in these activities?

How should Meredith’s actions be reported to Central City Internal Medicine, her employer?

What can the Central City do to prevent these problems from happening in the future?

Why is it important for HIM professionals to be familiar with laws that affect the management of personnel?

The Equal Employment Opportunity Commission website (EEOC), is introduced in the text. It lists a range of discriminatory practices that are banned by a variety laws.

Which one do you believe is the most risky for healthcare managers?

Your response should be based on the demographics of your locality.

Talk about the 1986 Immigration and Reform Act and what employers must know to comply with any other discrimination laws.

What’s the difference between nonexempt and exempt employees?

What classification would you prefer to be given if you could choose?


1: A Case Study Of Care One and Dr. Caremore

Doctors are guilty of medical malpractice when they exaggerate a patient’s situation to get them admitted to the hospital.

This malpractice must stop, as a Care One manager.

To verify the truthfulness of the allegations against Dr. Caremore, a thorough investigation must be conducted.

A thorough investigation should include questioning Dr. Caremore regarding this malpractice.

To prevent such malpractice from happening again, the doctor must be notified if such misconduct is found.

2: Dr. Pearson and Central City Internal Medicine Group Case Study

Utility fraud is the act of billing Dr. Pearson under Dr. Craig.

Uncredentialed service providers are often billed by offices under another credentialed national provider identification number until such provider is credentialed.

This practice can lead to audit recoupment and is therefore considered unethical.

The Central City Internal Medicine Group should address this problem and warn Meredith to ensure that Dr. Pearson is not billed under another doctor’s account.

All service providers must be billed using the care-rendering national provider identification.

Dr. Pearson must be billed under a different name and with a new tax ID.

3: Professionals Need To Be Aware of Laws Affecting Professional Management

HIM professionals need to be familiar with laws that affect the management of personnel. Health information managers work with a wide range of workers and in many settings.

Health Information Management professionals act as bridges between clinical operations and administrative functions.

HIM professionals are skilled and can help to protect confidentiality, integrity, and security.

It is therefore important that HIM professionals are aware of all laws affecting management personnel.

4: Equal Employment Opportunity Commission

This commission’s purpose is to enforce the federal laws of America if discrimination occurs against job applicants and employees.

Discrimination can be based on race, color, sex and origin.

Healthcare managers can be held responsible if they discriminate against employees based on these grounds.

The aforementioned commission is empowered to investigate complaints from employees alleging discrimination.

5: Immigration Reforms and Control Act 1986

On 6th November 1986, the Immigration Reforms and Control Act was passed.

This Act required employers to verify the immigration status of their employees.

Employers cannot hire illegal immigrants.

To avoid being charged with any legal action, employers who have at least 15 employees must ensure that there is no discrimination against any employee based on the Equal Employment commission.

6: Employees who are exempt and non-exempt

The Fair labor standards Act defines non-exempt employees as those who are entitled overtime pay.

When they work more than 40 hours per week, they are entitled to one-half the regular pay.

White collar exemptions are the most common exempted employee.

Exempt employees include executives, administrative staff, and computer professionals.

It is important to mention that if you have the option, it would be better to be classified as a non-exempt employee. Non exempt employees have the right to overtime work.

Refer to the Reference List

Connolly Jr. W.B., Connolly M.J., and Feinstein J., 2017.

An easy guide to equal employment opportunities.

Law Journal Press.

2013 Discussion Papers, pp.12-012.

Discussion Papers, pp.12-012.

Kiel, J.M. 2016,

Cham: Springer International Publishing.

Zimmer, M.J., and Sullivan C.A. 2017.

Materials and cases on discrimination in employment.

Wolters Kluwer Law & Business

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