UCLA A1 Coding Company Coding Services Case Study Discussion

Joe Winters, founder and part-owner of A1 Coding Company Coding Services, is preparing for a meeting with his business partner to discuss an important new business opportunity. A1 Coding Company is one of two finalists for a long-term outsourcing contract being offered by Bright Horizon’s Healthcare, the region’s largest integrated delivery system. Brain and his partner need to discuss their strategy for tomorrow’s business meeting with Jim Foster, Horizon’s CFO, and Liz Raymond, the corporate HIM director. To date, only Joe has been in discussions with Liz Raymond while he prepared the initial proposal. Joe knows Liz well and has worked with her on several committees of their regional and state HIM associations.

A1 Coding Company Coding Services is in its 10th year of operation. Joe and his partner have worked hard to build the firm into a successful business. The firm has enjoyed financial success by building a loyal clientele based on the expectation of high-quality services. It has grown slowly, but steadily, in size. Despite the firm’s moderate size, Joe knows that they were offered the opportunity to bid on this contract because of Joe’s relationship with Liz and the firm’s solid reputation for quality and reliable service.

The Bright Horizons business would represent a significant contract-potentially increasing revenues by 20 percent, by Joe’s estimate. It would also, however, require recruiting at least eight new coders, positions that Joe knows will not be easy to fill.

Joe also knows some things about the other finalist vying for the contract. ABC Coding Company Inc., is a large, national coding service that has grown even larger over the past few years, mostly through acquisitions of local and regional services. Joe has himself had several discussions with ABC Coding Company management about the interest in acquiring A1 Coding Company. Joe also suspects that ABC Coding Company is planning to offer deep discounts during final negotiations-discounts that will be difficult for Joe’s firm to match.

Joe knows a few other things about the competition that trouble him. Recently, he learned from a trusted source at another ABC Coding Company client that the hospital recently underwent a painful coding compliance audit and was slapped with a multi-million-dollar fine for coding improperties. Coding at the hospital is 100 percent outsourced to ABC Coding Company, and, worse yet, an ABC Coding Company coder is rumored to have been the whistleblower who initiated the coding audit. Joe’s source revealed that once the settlement between the hospital and the government is finalized, the hospital is likely to pursue legal action against ABC Coding Company for its coding performance and will be seeking substantial monetary damages. This news is currently confidential under a gag order imposed by the government, but, according to Joe’s source, it should become public knowledge within the next 60 to 90 days.

Up to this point, Joe has shared this information with no one – not with Liz or even with his partner. He wonders whether he should tell anyone what he knows. He also wonders how aggressively he should pursue the business with Bright Horizons, given the obvious advantages ABC Coding Company has over his firm. On the other hand, it would give him great satisfaction to win this business from a large conglomerate. It could also be a financial boom for A1 Coding Company. Further he is troubled by the allegations that he has heard against ABC Coding Company. He feels a loyalty to Liz and does not believe she is aware of the trouble in the other city. She fought hard for approval to out-source coding, and he would not want to see her badly served by ABC Coding Company.

Joe knows his partner will probably defer to his judgement on how to approach final negotiations. He just wishes he knew what to recommend as their best course of action. As he checks the clock, he sees that it is 3:45 pm and his partner will be back in the office in 15 minutes for their meeting.

Utilizing your decision matrix, answer the following questions supporting your reasoning:

  1. Does Joe have a clear course of action? Explain your answer
  2. What ethical issues should Joe ponder before advising his business partner?
  3. Are there general standards of business ethics that should inform his decision?
  4. Should his personal values enter into his business strategy?
  5. What strategies would you suggest for the upcoming business with Bright Horizons? Consider Joe’s loyalty to his firm? To its employees? Business partner? And colleague and potential client.
  6. In your opinion, elaborate on the course of action you would suggest Joe present to his partner and ultimately to Bright horizons.

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