Understanding insurance requirements


Case Problem:

Dr. Rodrigue is an obstetrician-gynecologist, who in 1989 opened her own practice. The financial support to open her new practice came from North County Women’s Health Care Services P.C., who provided her with start-up and relocation assistance and a practice consultant who helped draft and publish an employee manual. In November 1990, Rodrigue missed a sponsored event due to the mishandling of postal mail addressed to the practice. She then required all mail to be given to her, unopened, for her to open personally. She also hired Carol Wiltshire in May 1990. Although initially hired to work as a medical receptionist and secretary, over the nine years Wiltshire worked for Dr. Rodrigue, she held a variety of positions of increasing responsibility and authority within the office. In her position as billing specialist, Wiltshire was responsible for understanding insurance requirements and was the only person in the office trained in the Doctor’s Office Management System (DOMS) when Rodrigue converted to the computerized billing system in 1992. DOMS software is used to manage accounts by tracking charges, payments, and adjustments. From 1992 until her termination in 1999, Wiltshire was solely responsible for entering charges, adjustments, and payments and closing out monthly statements for patient charges by using the DOMS software. After learning how to use the software, Wiltshire began stealing checks from various insurance providers payable to Rodrigue from the doctor’s mail. During the course of her employment at Dr. Rodrigue’s office, Wiltshire stole 269 checks, totaling $372,572.18, written by insurance providers to Dr. Rodrigue. Between 1994 and 1995, the office began to face financial troubles. Rodrigue finally discovered Wiltshire’s embezzlement at the end of November 1999, after her sister-in-law, Denise Rodrigue (Denise), told her that she believed Wiltshire had been taking mail into her office, opening it, and stealing insurance checks. Which terms of negotiable instruments does this case fall under or describe? [Rodrigue v. Olin Employees Credit Union, 03-2470, 03-2607 U.S. Court of App. Seventh Circuit (2005).]

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Business Law and Ethics: Understanding insurance requirements
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