Ethics Resolution Assignment

Students in the group: Sidney, Ashley, Alyssa M., Raquel, Jordan

Name of scenario: #4: “Doing the best for clients”

Framework for ethical decision-making: Answer the following questions in your group. In
each of the scenarios, you are the manager and will need to think about how the approach you
take will affect all parties.
List all of the involved parties: Make sure you consider the whole scope of the problem and list
everyone who may be affected by any decision you make.
Involved parties: Clients, Home health OT, home health manager, insurance/billing, board of
directors (agency)

Consider the OT ethical standards: Review the ethical standards and create a bullet list of the
principles that apply to the main parties (you do not need to write an explanation of your
choices).
● Beneficence: providing services that are not within the scope of practice
● Nonmaleficence: inaccurate coding/ documentation
● Justice: billing for services outside of the scope of practice
● Veracity: Documentation may be false, fraudulent, deceptive, misleading, or unfair
statements or claims.

Frame the problem: As the manager, you will need to explain the problem to the main involved
parties from the standpoint of their own involvement. Select the main 2-3 people involved and
write a paragraph framing the problem to each of them. Consider each of their unique
perspectives and explain the problem in factual and non-blaming terms.
OT: Hi Sam (OT), I wanted to talk to you today about your documentation and recent reports
from clients regarding your therapy visits. As I read your documentation, I am not sure if there is
missing information or a potential lack of inclusion of information because they seem shorter
than your previous notes or the notes of your peers. Is this correct, what is your perspective? I
also had spoken to some of your past clients to check-in to see how things are going and their
satisfaction of services, and although they approved of you and were satisfied, they had
mentioned occurrences where you ran errands for them. I wanted to get your side of the story
and your perspective on the situation to resolve this. One of the main reasons I feel that this
needs to be addressed is because I am seeing a request for reimbursement and need to ensure
that those services are in fact skilled. Can you give me your explanation and perspective on this
matter?
Billing/Insurance: We have received reports about one of our OTs that there is suspicion of
them potentially not providing full documentation of their services. Please hold on any
reimbursements for this OT’s services until further notice, as we suspect he may have been
providing services to the client outside of the scope of OT practice and intend to investigate it.
We will get back to you on this matter shortly.

What do you know, what do you need to know, and what resources can you use to supplement
your understanding: It is important to make as informed a decision as possible. Make a bullet
list of the facts you know, then make a two-column table with a line item list of the information
you need and a source you could go reference to get the information.
Facts you know:
● OT has been running errands for clients and completing home maintenance tasks.
● OT reports high productivity.
● OT has a high client satisfaction rate.

What do you need to know: Resources

What is the OT billing for? Codes used to bill insurance

Is the OT providing any skilled OT service? Documentation, client report. State

regulations for home health.

Are clients’ therapeutic goals being met? Client report, documentation of STGs being
met.

Does the OT know what they can/cannot bill Consensus Statement on Clinical Judgment
for? in Health Care Settings AOTA, APTA, ASHA.
Local laws, Insurance codes and policies.
Therapist report, Licensure regulations,
practice acts, rules

Make a decision: What course of action will you choose and why. Give details about how each
of the interested parties will be affected by your decision. This will not be a short answer as the
manager, you will have to help all parties get “on board” with your decision to the extent that you
can. This is the crux of being a good manager. The ability to communicate difficult decisions to
all parties and help them understand the whole picture (at the appropriate level). Write up the
course of action you will take and then write a paragraph to each of the main interested parties,
explaining your decision as it relates to them.
Action plan:

The action plan with the OT would initially consist of conversing with the OT to
sort out any perspectives or points that the OT wants to make in regard to this problem.
This allows both parties to discuss the problem to gain a greater view of the situation.
This conversation would include providing education regarding what is within the OT
scope of practice, his role in therapy, and various resources he could provide that would
allow the client to still get those resources without the OT having to actually run those
errands for him. In addition, his documentation would be reviewed and education would
be provided on the expectations of documentation and what it should look like upon
submission.
After this conversation, a timeline would be created to gain a greater
understanding of how long this has been occurring. His documentation would be audited
and an investigation of his services would occur. Following this deep investigation on the
OT’s actions, documentation, with consideration of the conversation with the OT, the OT
would be put on administrative leave until the solution of the investigation is solved.
Depending on the result of what the investigation yields (applying to the specific
case information above) the OT would be allowed to come back with some exceptions
before he can see clients independently again. He would need to complete an ethics
training upon returning and develop a resource plan to use with his clients. This would
take the place of him physically running the errands for the clients. Once he has
completed those two items he will have his documentation supervised and require
approval by the manager before submission. He will also be notified that the manager
will be checking in with his clients to gain a report of his services he provided to ensure
that errands were not part of the session or took place after the session.

OT: After collecting information on the history of the content of your treatment with
clients, I am concerned that the billing codes you have used do not correctly document
treatments. This is concerning, not only because of the implications with insurance, but
that treatments have consisted of activities outside of the scope of OT. While I am
further investigating the details of your past documentation and interventions, you will
temporarily be put on administrative leave. I will create a remediation plan for you to
follow after your return to work, to help guide your growth and learning, with the
expectation that you will report correct billing codes and only perform activities
appropriate for an OT in the future.

Billing/insurance: It appears that one of our OTs was billing for services that were not in
the realm of skilled OT services. After investigation and auditing of the therapist's
documentation and client report of services given, a plan will be set in place for either
the company or the OT to reimburse the money that was improperly billed. To ensure
that we maintain best practices, this therapist will be put on administrative leave and will
be completing a remediation plan. This will ensure that the therapist knows precisely
what skilled service they can provide and supervision of proper documentation/billing will
be monitored.