Why Ethics Can't Be an Afterthought in Healthcare Finance

As public trust declines and technology transforms decision-making, CFOs must lead with ethics, not just compliance.

Plato once said, "Good people do not need laws to tell them to act responsibly." In healthcare finance today, acting responsibly requires more than laws: it demands unwavering ethical leadership.

As trust in healthcare institutions continues to erode, finance executives are navigating murkier waters. Surveys show trust in government health agencies fell to 61% as of January 2025, while confidence in physicians and healthcare leaders declined 12% since 2023. Layer in the surge of misinformation and growing distrust in media, and the job of stewarding financial decisions that impact patient care becomes entrenched with ethical complexity.

A session at the recent HFMA Annual Conference tackled this challenge head-on, making the case that finance leaders must proactively engage with ethics and not shy away from it.

The Basics Still Matter

Led by former CFO and HFMA senior vice president Rick Gundling, the session opened by grounding attendees in ten core ethical principles that serve as practical reminders amid healthcare's growing complexity. These include:

• Screen and stabilize all patients who seek emergency treatment regardless of their ability to pay.
• Provide high-quality patient care without asking for or taking anything of value for referrals.
• Bill only for medically necessary services provided.

While some of these may seem obvious and foundational, Gundling emphasized how easy it can be for leaders to lose sight of these basics. Revisiting these principles is critical as finance teams weigh both routine decisions and high-stakes strategic pivots.

It's imperative to maintain an ethical tone at the top, in the C-suite, Gundling advised. Leaders at this level decide whether ethics count and must model not by what they say, but by what they do.

To help leaders systematize their approach, Gundling introduced a five-step framework to navigate ethical decisions with rigor and consistency:

1. Identify the ethical issues.
2. Get the facts.
3. Evaluate alternative actions through different lenses.
4. Choose an option for action and test it.
5. Implement your decision and reflect on the outcome.

AI and the Ethics of Innovation

As artificial intelligence becomes more integrated into clinical, administrative, and financial operations, CFOs will be called on to address new ethical frontiers, according to Gundling. There are both legal and ethical considerations that leaders must grapple with as AI grows across health systems.

Under the ethical umbrella, leaders will need to consider regulation, privacy, mitigation of bias, transparency and relevance. Meanwhile, under the legal umbrella, leaders will need to think about governance, confidentiality, liability, accuracy and decision making.

Emerging topics like robot rights, algorithmic inclusion, and machine-led cognitive services may seem distant, but Gundling stressed that forward-thinking CFOs should engage with these now rather than reacting later. Moreover, he posed a critical question: when does existing policy need to evolve to meet new ethical challenges?

The Ethical Bottom Line

Gundling left attendees with a powerful reminder: being ethical is about more than checking a compliance box. It's about judgment, intent, and clarity of values, especially with external pressures like Medicaid funding cuts and intense public scrutiny.

Gundling closed the session with three essential truths for finance leaders:

• Morals are principles; ethics are the behaviors that reflect them.
   
• No matter how robust the policy, ethical judgment is often a solo act.
   
• Technology is reshaping what ethical decision-making looks like, so stay ready.