Problem
Health care professionals are all required to comply with fraud and abuse laws, but individual organizations may have different approaches to managing violations internally, and reporting to external entities. As a hospital administrator, you supervise a team of coding and billing professionals. If someone on your team violates a law by unintentionally submitting the wrong information on a claim, is this fraud or abuse? Explain the rationale for your decision What repercussions may occur for this employee, external to your organization (state, federal)? What repercussions may occur for this employee, internal to your organization? How can this violation be used as a learning opportunity for this employee and others?