You have a friend, Robert Baratheon, who is a physician, and whose ex-wife, Cersei Lannister, owns a durable medical equipment supply company,...
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You have a friend, Robert Baratheon, who is a physician, and whose ex-wife, Cersei Lannister, owns a durable

medical equipment supply company, Lannister Home Care, in Myrtle Beach. Dr. Baratheon can refer patients to the durable medical supply store where they obtain their hospital beds, walkers, crutches, oxygen bottles, and motorized scooters, among other supplies. The patients receive a special discount when they are referred to Lannister Home Care and they greatly appreciate the savings. Many of the patients would not be able to afford their purchases without this discount and this referral pattern has saved the patients tens of thousands of dollars. 

 

In turn, Lannister Home Care gives a monthly bonus to your physician friend based on the sales that the patients referred by his practice generate in equipment and supplies. Your friend is under the impression that the monthly bonus is given to him because he provides patients a list of all durable medical equipment stores in the area. In his mind, there is no overt referral to Lannister Home Care. However, the bonus increases and decreases based on the number of patients that come from his practice. The Dr. Baratheon never sees these increases and decreases in the bonus because his billing manager intentionally never reveals it to him and he never knows to ask. He just assumes that all is being lawfully run. Lannister Home Care bills Medicare or the patient's health insurance company if the item is covered by the patient's insurance plan. 

What advice do you give to your friend, Dr. Baratheon?

First, write out the name of the rule and the rule language (from the text Introduction to Health Care Management

by Buchbinder, Sharon Bell Shanks, Nancy H.) that guides your advice. Next, provide your advice in full with support from the rule that you have written. 

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