Sally Guthfield works for Allied Health,Inc.,a company that owns hospitals and clinics in 14 states.Sally works in billing and has noticed a great deal of "upcoding" in Allied's billing practices."Upcoding" is when the patient's condition and treatment are overstated as a way of obtaining higher reimbursement rates from the federal government for Medicare and Medicaid patients.Sally talked with her supervisor who explained that billing more means higher revenues and upcoding was a way to achieve that.Sally was unable to change the billing philosophy and left Allied after reporting the company to the Department of Health and Human Services.Sally provided this federal agency with billing records and information.The federal government was able to recover almost $500 million from Allied.Under the False Claims Act:

Question

Sally Guthfield works for Allied Health,Inc.,a company that owns hospitals and clinics in 14 states.Sally works in billing and has noticed a great deal of "upcoding" in Allied's billing practices."Upcoding" is when the patient's condition and treatment are overstated as a way of obtaining higher reimbursement rates from the federal government for Medicare and Medicaid patients.Sally talked with her supervisor who explained that billing more means higher revenues and upcoding was a way to achieve that.Sally was unable to change the billing philosophy and left Allied after reporting the company to the Department of Health and Human Services.Sally provided this federal agency with billing records and information.The federal government was able to recover almost $500 million from Allied.Under the False Claims Act:​

Quizplus · Accepted Answer

Sally is entitled to collect up to 30% of the amount recovered from Allied under the whistleblower provisions of the False Claims Act. She cannot be held responsible for submitting the upcoded bills as she reported the issue to her supervisor and then to the Department of Health and Human Services. She also did not violate federal law by turning over the records of her employer to a third party as she was acting as a whistleblower and providing information to the government to recover funds obtained through fraudulent billing practices.

Sally Guthfield Works for Allied Health,Inc