A recent survey by Black Book Research has revealed alarming ethical challenges within the Health Information Management (HIM) industry—challenges self-reported by professionals in the field. The findings suggest a widespread culture of unethical leadership and fear of retaliation for speaking out.

Key issues raised include:

• Manipulation of Risk Scores: 7% admitted to accusations of inflating risk scores to increase reimbursements, with nearly half expressing concerns about coding integrity.
• Upcoding for Higher Reimbursements: 90% flagged “upcoding”—assigning higher billing codes than justified—as a major ethical concern that raises healthcare costs and exposes providers to legal penalties.
• Pressure to Commit Fraud: 18% reported feeling pressured by employers to engage in fraudulent coding for financial gain.
• Bias in Social Determinants Coding: 69% worry that coding for social factors like housing or education could reinforce biases in healthcare and impact patient care unfairly.

While the AHIMA Code of Ethics urges professionals to uphold transparency and refuse unethical practices, these findings suggest that internal pressures often make it difficult for them to do so. The question remains: Who will stand with these professionals to ensure ethical integrity in healthcare?

As Theodore Roosevelt said, “To see what is right and not do it is want of courage.” If we ignore the voices of those raising these concerns, we risk sacrificing both the ethics of the industry and the trust of those it serves.