Don’t Al­ways Blame the Guys at the Top

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VET­ER­ANS POST by Freddy Groves

At a De­part­ment of Vet­er­ans Af­fairs med­i­cal fa­cil­ity, a psy­chol­o­gist by the name of “Z” man­aged to find a way to in­crease in­come by over­stat­ing pro­duc­tiv­ity by 43 per­cent.

This was done via dou­ble cod­ing. Say the ap­point­ment with a pa­tient should be clas­si­fied as 123. The psy­chol­o­gist would code it as 123 and ad­di­tion­ally as 456 ... mean­ing Z would ap­pear to have done more work. Z av­er­aged 15 hours of ac­tual work in a 40-hour work­week yet man­aged to ac­crue pay­ments for 243 hours of over­time.

Ap­point­ments were done on Z’s per­sonal plan­ner, not the com­puter where they could be no­ticed. They were en­tered in the com­puter only af­ter the ap­point­ments.

Z was caught and claimed that the dou­ble cod­ing was per the in­struc­tion re­ceived in ini­tial VA train­ing, yet Z didn’t at­tend seven of the eight train­ing ses­sions on cod­ing. Fur­ther, it was in none of the train­ing ma­te­ri­als and the other psy­chol­o­gists were not given that in­struc­tion.

The pun­ish­ment? Make Z go to cod­ing class. No ad­min­is­tra­tive steps were taken, no fir­ing, no ap­par­ent re­im­burse­ment of the over­pay­ments.

The chief of psy­chol­ogy was dragged into it for fail­ing to su­per­vise the cod­ing and the hours Z ac­tu­ally worked. The chief of health in­for­ma­tion man­age­ment was pulled into the mess for fail­ing to over­see cod­ing re­views, which would have caught the er­rors, claim­ing she didn’t know of the re­quire­ment.

It gets bet­ter. The chief of med­i­cal ad­min­is­tra­tion and the as­sis­tant chief didn’t know those re­view du­ties ex­isted.

It gets even bet­ter. The med­i­cal cen­ter’s di­rec­tor wasn’t aware that cod­ing re­views weren’t be­ing done.

How many lay­ers is that? The med­i­cal cen­ter di­rec­tor is ef­fec­tively sup­posed to do the job of all those un­der­lings?

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