The recent case of Hertel and Brown outpatient therapy (Hertel and Brown Blog) is an eye-opener that every practice, regardless of size or type, needs to be aware of the importance of ethics.

Ethical Practice

Ethics and moral principles should guide clinicians in every aspect of patient care. State licensing boards and national organizations outline expected ethical behavior and consequences for non-compliance. Clinicians, supervisors, and practice owners should be familiar with the applicable state’s ethical principles and the disciplinary actions that can occur when there are confirmed ethics violations. Licensed clinicians and management must also be aware of the state’s reporting requirements for suspected and confirmed ethical violations.

Know the Rules

The Federation Forum Magazine originally published, “Ten Easy Ways to Lose Your License” in Volume 21, Number 3. The Board of Allied Health Professions in Massachusetts (MA) offers a program, “Ten Easy Way to Lose Your License”, that teaches the rules and regulations governing the profession. Unethical behavior can range from fraud, sexual misconduct, and patient abuse to medication violations. But did you know that poor documentation or record-keeping can also be seen as unethical by many state licensing boards? The training offered by MA includes modules that describe why adherence to the guidelines is important and how non-compliance could lead to disciplinary actions, for example, loss of a clinical license or fines.

Unethical Behavior-The Risk

Ethical violations pose a potential risk to the organization. An organization may be held liable for the confirmed unethical practice of an employee engaged in fraudulent billing or if harm occurs to a patient by a clinician functioning outside their scope of practice. Consider the potential corporate liability if a clinician causes patient harm while under the influence of alcohol or illicit drugs. Suppose there was documentation (or at least knowledge by management and staff) of the substance abuse but a lack of follow-up. In this scenario, potential liability is significant for the organization as well as the offending clinician.

State licensing boards outline ethical standards, reporting requirements, and consequences of confirmed ethical violations. Organizations should include ethics training as part of the onboarding process. State licensing board reporting requirements for unethical behavior is important information for clinicians and management alike to know.

Establish the Standard–Do the Right Thing

Cultivate a corporate culture of ethical behavior because ethical practice is the “right thing to do.”  Create an environment where self-reporting and peer-reporting are encouraged and supported without fear of retaliation. Explain the macro perspective of ethics adherence for promoting safe, quality, and effective patient care while simultaneously fostering a positive corporate reputation and facilitating a positive work environment.

Examples of Possible Ethics Violations [Each state defines punishable offenses]

  • Practicing outside one’s scope of practice
  • Failing to practice within generally accepted standards
  • Failing to maintain adequate patient records
  • Failing to provide the required level of supervision for assistants, aides, and students
  • Failing to report to the licensing board direct knowledge of unprofessional, incompetent, or illegal acts in violation of the licensing board rules
  • Sexual misconduct
  • Promoting and/or providing unnecessary devices or treatments for financial gain
  • Practicing therapy when mentally and/or physically impaired
  • Failure to maintain patient confidentiality

Uncovering Unethical Behavior

As a supervisor, manager, or business owner, how do you monitor unethical behavior? Documentation audits that include a review of billing and coding may reveal deviations from standard practice and/or abhorrent clinician practice. Well-trained and highly knowledgeable auditors are essential. The auditor must be familiar with state guidelines governing the profession, payer requirements, and clinical practice guidelines established by the professional organization and payers.

Organizations can also uncover potential ethical problems through treatment observations and staff rounding. When an ethics violation is suspected the organization’s process of investigating the allegation must be followed. The Compliance and Human Resource Departments may take the investigator’s lead.

LW Consulting, Inc.  Can Help!

  • LW Consulting, Inc.’s (LWCI) experts can conduct clinical documentation audits that include billing and coding (ICD-10 and CPT).
    • Regulatory compliance
    • Best clinical practice
  • Our experts can also conduct scheduling audits.
  • LWCI’s experts have experience with appealing denied claims for all settings and at all levels of the denials process.
  • Our experts can assist clients in developing Patient Care Policies and Procedures and in developing and conducting Staff Competency Training with Attestation Acknowledgement.

LW Consulting, Inc. can assist you with your compliance program and/or conduct a documentation and coding audit. For more information, contact Kay Hashagen at [email protected] or (410) 777-5999.