Question

Fraudulent billing

Conduct a search and select a peer-reviewed journal article published within the last five years related to the topic you selected.

Post a brief summary of the article you selected. Include the key reimbursement issue addressed and how they would impact the NP in a collaborative practice versus and independent practice. Discuss an ethical or legal implication(s) associated with your article.

Answer 1

A New York Times article published in September 2015 by headings"Red Flags in the Realm of Skilled Nursing Facilities—The Future of the Payment System " highlighted an increase in fraudulent Medicare billing practices in skilled nursing facilities (SNFs) following investigation by the Office of Inspector General (OIG) .

The key issues discussed includes:

(1) reduce the therapy rate and analyze how to set an appropriate new base rate.

(2) change the method for paying for therapy

(3) adjust Medicare payments to eliminate any increases that are unrelated to beneficiary characteristics and

(4) strengthen oversight of SNF billing.

The article also addressed “ultrahigh therapy,”(classifying more and more patients as needing the highest level of therapy and providing exactly that amount required to qualify for high payments).

IMPACT BETWEEN COLLABORATIVE AND INDEPENDENT NURSING PRACTCE:

Collaborative nursing practices in my opinion have more pros as compared to independent Nursing practioners as they can avail suggestion and opinions from the team and bring about the beficial care to the client in limited time but with respect to the fraudulent billing unless their is a standardised policy on billing there can be illegeal practices in both practices.

ETHICAL AND LEGAL IMPLICATIONS

The ethical and legal concerns the following :

• Challanges in treatment effectiveness: In most cases the question to what extent the treatment is effective and the outcome of the treatment provided should be adherent to the patients need.Avoiding addition procedures not relevent with his condition.
• Provision of Quality of care over quantity: The ultimate goal each healthcare is to attain Quality health care,therefore keeping that in mind the institution should provide the client with a standardised care.
• Inappropriate Medicare payments,Discrimination,Torts such as false imprisonment (false detention of client) are somr of the few examles in relation to client related fraudulent billing.