If an office manager instructs a coder to engage in fraudulent activity, who is at the greatest risk for being charged?

When discussing the scenario where an office manager instructs a coder to engage in fraudulent activity, the coder holds a significant amount of risk for being charged. This is primarily because the coder is the individual who has the authority and responsibility to interpret and process medical coding, which can involve critical ethical and compliance standards.

In cases of fraudulent activity, regulatory bodies and legal frameworks often hold individuals accountable based on their direct actions and decision-making. Although the office manager initiated the instruction, the coder not only executed the action but also might have the opportunity to recognize and report the wrongdoing. Their failure to do so could be interpreted as complicity in the fraudulent activity.

Additionally, from a legal perspective, both federal and state laws such as the False Claims Act can impose liability on individuals who knowingly submit false claims for payment. This means that the coder, having carried out the fraudulent activity upon the manager's instruction, directly places themselves in a vulnerable position regarding potential charges.

The other individuals mentioned are also at risk; however, the coder's role in the execution of the fraud positions them foremost in terms of liability due to their technical capabilities and awareness of the coding process.