Question

Read each of the case studies presented, and explain, What your opinion is and how you arrived at it.

Case Studies

A. Brent underwood, a health insurance professional in the Beach Front Medical Clinic, is convinced by Bertha Parker, a 60-year-old patient of the clinic, that she is a "financial hardship" case. Brent tells Ms. Parker that he will send in a claim to her insurance company and "write off" any balance that they do not pay. Determine if Brent is within this legal rights as a health insurance professional to do this for Bertha. If not, decide if his actions constitute fraud or abuse.

B. Mary Larson visits Dr. Jacob Astor, her obstetrician, for a suspected pregnancy. Dr. Astor performs an examination, determines she is pregnant, and asks you, one of his versatile healthcare professionals, to arrange for an ultrasound. The office is busy, so you inform Mary that you will schedule the procedure later and call her with the appointment date and time. Later that day, you telephone Mary’s residence and her husband answers the telephone. You inform him of the appointment time that has been set up for Mary’s ultrasound. Is this a breach of confidentiality? Why or why not?

C. You are employed as a health insurance professional for Dr. Gail Lorber, a family practice physician. Dr. Ian Sutton telephones from the State University epidemiology laboratory. He informs you that he is doing a clinical study on infectious diseases and is requesting a list of all patients who have been treated for hepatitis A, B, and C in the past 5 years. Do you need to procure a written release from each patient to give this information to Dr. Sutton? Why or why not?

Answer 1

1.To "write off" means that the insurance professional is trying to remove certain data from the claim which can cut off the cost for patient. This is an act of fraud  because write off can lead to non reimbursement of the claim for the healthcare service received by a patient .This can lead to financial loss to a healthcare organization .

2.This is a breach of confidentiality as the staff has informed the patient details to the non consented person by the patient .In these type of cases the healthcare professionals has to ensure that the appropriate patient is informed or else the consented person is informed to avoid legal consequences .This is applicable both for telephone and direct contact when dispatching information.

3.A written release or consent has to be given by the patient in order to release the most sensitive information of them which they wish to keep in confdentialty. Though it is for research purposes disclosing patient information without consent can be considered to be breach of privacy and confidentiality .