[Verified Answer]: knowing whether to say anything, Windsor…

knowing whether to say anything, Windsor decides to Whice in Ka again after clinic is over. After oxplaining the discrepancy, Ka agrees that it is indeed odd that Dr. Walley’s signature is the only one on the notes. What is even more odd is this is only happening for patients who have Medicare. They cannot decide if they should take this concem to their practice manager or wait to see if the issue resolves itself. Dr. Walley ends up going on vacation for the next two weeks, so Windsor decides not to pursue the issue until then. However, after arriving at work a couple of days later, Windsor notices the NP and the practice manager sitting in the conference room with individuals dressed in professional suits. Windsor learns from other coworkers that the individuals are lawyers representing the clinic. Though management tries to keep the issue hush-hush, it eventually makes it around the office that the clinic got audited by the government and discrepancies were recognized. Chief among those discrepancies is that the clinic has an abnormally large number of reimbursement claims for physician visits, yet a relatively small number of reimbursement claims for NP and PA visits. Upon further investigation, it became known that the clinic had been billing Medicare the physician rate for office visits even when patients were only seeing a PA or NP during their visit. Upon learning this information, Windsor understands now why Dr. Walley’s signature was appearing on all the notes, despite the NP being the one who actually saw the patients in clinic. Afraid of getting in trouble, Windsor does not say anything about noticing the signature discrepancies and advises Ka to do the same. It finally dawns on Windsor, though, what the providers had been up to all those months ago during their secretive meeting. They had been designing a scheme to increase the clinic’s revenue by submitting fradulent claims on their Medicare patients. Windsor cannot help but wonder if mentioning this months ago could have helped or whether the lesue could have been avoided alt wgether. Now they can only hope that the thousands of dollars the clinic must repay Medicare does not end up costing them their jobs. Discussion Questions What are the first indications in the case study that suggest medical fraud was occurring in the practice? If you had been in Windsor’s shoes when the discrepancies between what provider was seeing the patient and what provider was signing the notes, would you have confided in a colleague or would you have taken the concern to management? Explain your rationale. If you took a concern like the one Windsor had to your practice manager and they ended up dismissing it without investiguting it, do you believe you would have an ethical responsibility to report the suspicious activity to an objective third party? Who might you be able to report such an issue to outside of your practice? Do you think the providers or clinic in this case are going to face legal consequences beyond having to pay back the money they owe to the government?