Your supervisor asks you to ignore Sponsor's process and to adjust/add risk diagnosis codes for certain individuals. What should you do?

• A. Report the incident to the compliance department (via compliance hotline or other mechanism)
• B. Follow the supervisor's instruction
• C. Document and do nothing
• D. Seek legal counsel

Answer: (A)

When someone asks you to ignore established processes and change risk diagnosis codes, this signals potential fraud, waste, and abuse and threatens data integrity and proper reimbursement. The appropriate action is to report the incident through the organization’s formal compliance channels (such as the compliance hotline or ethics/compliance office). This starts an official investigation, protects you under whistleblower protections, and ensures the improper activity is stopped and addressed according to policy and legal requirements.

Following the supervisor’s instruction would enable wrongdoing and compromise the integrity of coding, claims, and oversight. Documenting and doing nothing leaves the concern unaddressed and could expose you and the organization to greater risk. Seeking legal counsel can be a prudent step if you need guidance on legal implications, but the immediate and correct action is to report the situation so compliance experts can respond appropriately.