AOTA Code of Ethics: falsified documentation scenario

Read the question list carefully, because the first one is narrower than it looks. *What would you do?* is asked in a scenario where the conversation happened at lunch, at the weekend, outside work, with a colleague from another employer — so the answer is not simply 'report her'. It has to work through what you actually know (a stated intention, described as common practice, with no named child and no evidence), what your obligations are, and what the realistic first step is: addressing it with her directly, then escalating if it is real and continuing. An answer that jumps straight to a formal report has skipped the reasoning; an answer that says nothing because it was a private conversation has misunderstood the obligation. Setting out what you would do first, and what would change your mind, is what turns this into an ethical judgement rather than a rule lookup.

The second question is the most mechanically checkable, and it is worth being precise rather than gesturing at ethics in general. The AOTA 2020 Code sets out **six** principles — Beneficence, Nonmaleficence, Autonomy, Justice, Veracity and Fidelity — and this scenario engages several at once. **Veracity** is the most direct, since recording services that were not provided is the opposite of comprehensive, accurate and objective information. **Nonmaleficence** applies because children who need therapy do not receive it. **Justice** is engaged because falsified records misallocate a scarce, publicly funded resource. Note that the question says principle**(s)**, plural — naming only one is answering a smaller question than the one asked. Quote the clause you are relying on rather than paraphrasing the principle, since the Code's own wording is what the marker will check against.

Do not lose the children in an answer about professional conduct. These are students on IEPs, and an IEP is the primary vehicle for delivering a free appropriate public education under IDEA, with frequency and duration of related services written into it as a legal commitment. Documenting sessions that did not happen is therefore not only dishonest paperwork: it produces a record showing the IEP was implemented when it was not, which conceals the shortfall from the team and the family and removes the trigger that would otherwise prompt a review. That is the harm — the falsification hides the very failure that would have caused the caseload problem to be addressed. It also explains why the caseload problem never gets fixed: the records show compliance, so nothing escalates.

The state-versus-national distinction the third question asks for is a real structural difference and the marks are in keeping them apart. **State level** is licensure: the state regulatory board can investigate, and sanctions range through reprimand, probation and conditions on practice to suspension or revocation of the licence to practise in that state. **National level** is certification and federal exposure: NBCOT can act against certification, AOTA against membership, and because school-based services are frequently billed to Medicaid, falsified records can reach the False Claims Act — which carries treble damages plus per-claim penalties and, importantly, does **not** require proof of criminal intent, since deliberate ignorance or reckless disregard is enough. Say which mechanism sits at which level explicitly, because merging them is the single commonest error in answers to this question.

The final part — *what do you think should be her punishment* — is asking for your judgement, so give one and defend it rather than restating the sanctions available. The strongest answers distinguish between the conduct and its cause: falsification is a serious integrity breach that has to carry a real consequence, and a caseload that makes IEP compliance impossible is an organisational failure that sanctioning one therapist does not fix. Saying both, and being explicit that the second does not excuse the first, is a more defensible position than either maximum severity or sympathy alone. Her claim that *every OT does it* is worth naming directly as a normalisation argument, which is a warning sign rather than a defence. A short paragraph on what the employer should have done alongside the sanction rounds the answer out without excusing anything.