Making ethical decisions Charlie Anderson recently began a new job as the office manager for a prominent medical clinic. He has just received a bill from MedCount, one of the labs that performs tests for the clinic. In reviewing the bill, Charlie notices that the lab has charged the clinic $25 for a complete blood count test. The clinic, however, bills patients or their insurance companies $90 for the test, and that is the amount that most insurance companies will pay on the patient's behalf. Thus, the clinic is earning a $65 profit on each blood test it orders. After a bit more investigation, Charlie finds similar profit margins on several other lab tests. He is concerned about the billing practice and suspects the clinic may have selected the lab based on its low cost rather than on the lab's qualifications and the accuracy of its test results. He also wonders if the tests' profit potential is driving doctors to order unnecessary tests.

American Medical Association (AMA) Code of Medical Ethics:

AMA Opinion E-8.09(2) states, [a] physician should not charge a markup, commission, or profit on the services rendered by others. This opinion describes a markup as an excessive charge that exploits patients if it is nothing more than a tacked on amount for a service already provided and accounted for by the laboratory. The opinion does allow the clinician to bill an acquisition charge or processing charge but that the patient should be notified of any such charge in advance. Moreover, this opinions states that a physician who disregards quality as the primary criterion or who chooses a laboratory solely because it provides low-cost laboratory services on which the patient is charged a profit, is not acting in the best interests of the patient.

1. Based on the information provided above, respond to the following questions in complete sentences:
   1. Do you believe that the clinic's billing for lab tests is an acceptable business practice?
   2. Why or why not?
   3. How could implementation of a proper code of ethics by MedCount help the medical clinic from avoiding an ethical violation?
   4. In your own words, define ethical behavior.