Case Study: Miami Dade Medicare Fraud Case

In the Code of Ethics for Nurses provision 4 states “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.” This was not done, there was no regard for human life. The patients in the hospital were treated as a burden. A meeting was held where the doctors agreed that

The plaintiff in Ard v. East Jefferson General Hospital, stated on 20 May, she had rang the nurses station to inform the nursing staff that her husband was experiencing symptoms of nausea, pain, and shortness of breathe. After ringing the call button for several times her spouse received his medication. Mrs. Ard noticed that her husband continued to have difficulty breathing and ringing from side to side, the patient spouse rang the nursing station for approximately an hour and twenty-five minutes until the defendant (Ms. Florscheim) enter the room and initiated a code blue, which Mr. Ard didn’t recover. The expert witness testified that the defendant failed to provide the standard of care concerning the decease and should have read the physician’s progress notes stating patient is high risk upon assessment and observation. The defendant testified she checked on the patient but no documentation was noted. The defendant expert witness disagrees with breech of duty, which upon cross-examination the expert witness agrees with the breech of duty. The district judge, upon judgment, the defendant failed to provide the standard of care (Pozgar, 2012, p. 215-216) and award the plaintiff for damages from $50,000 to $150,000 (Pozgar, 2012, p. 242).

The two provisions from the Nursing Code of Ethics that were violated are Provision 2 and 3. Provision 2 states “the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population” (Brown, Lachman & Swanson, 2015). Provision 2 focuses on “the nurse’s obligation to assure the primacy of the patient’s interests regardless of conflicts that arise between clinicians or patient and family”(Brown, Lachman & Swanson, 2015). Provision 2 was violated because the nurses

While the seriousness of a patient’s death should be investigated, the hospital failed to act promptly and investigate the supervisor’s or human resource (HR) department’s denial of reasonable accommodations or the previous errors made by the nurse. Therefore, the wrongful termination seems more likely to have been the case in this situation. The defense will show that rather than terminating her employment earlier the hospital waited until something catastrophic happened. The nurse took appropriate action discussing her health condition diagnosed by her physician that precludes her from working in the ER at full capacity with her supervisor. The nurse should have been given alternative assignments as appropriate or disability leave if no other alternative was available and should not have been terminated wrongfully after the incident (Pozgar,

If testing results support the suspicions of impairment, then management is mandated to report the incident to the North Carolina Board of Nursing (NCBON, 2011). With increased medication errors, Beverly failed to provide a safe and effective nursing care to the patient, therefore violating the laws of the Nurse Practice Act (NCBON, 2009).

The event that essentially precipitated the criminal charges against Ann Mitchell and Vicki Galle was when they reported the unsafe medical practices of Dr. Ronaldo Arafiles. They stood up for many of Dr. Rolando Arafiles patients and their rights. They felt as if Dr. Arafiles was not providing standard care for his patients. After they filed an anonymous complaint to the Texas Medical Board (TMB), Winkler County Sherrif Robert Roberts requested copies of the confidential complaints and notified Dr. Arafiles. Following this action, the sheriff and Dr. Arafiles a attempted to retaliate against the two nurses (Sack, K). After reviewing the outcome of the case, the nurses were both impacted negatively. They will probably never be hired into the

In the news recent was the Miami physician pleads guilty for role in $20 Million health care fraud scheme (Justice. Gov). The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida (Justice.

Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).”

Ellen Hughes Finnerty, a registered nurse, was found guilty of negligence and incompetence, and was consequently disciplined by the Board of Registered Nursing. Accordingly, Finnerty’s license was revoked, and she was placed on a three-year probation. The following timeline gives a detailed summary of events that led to the conclusion of nursing negligence and incompetence on the part of Finnerty (NDC Learning House, 2015).

fraud risk exclusion from participation in Federal health care programs and the loss of their

Healthcare finances does not come without legal and regulatory issues. Issues in healthcare finances are false claims and whistleblower suits. The False Claims Act is a federal law that cover fraud in any federal funded program such as Medicare and Medicaid. This act covers knowing or conspiring to falsify any claim for payment by the federal government. In 2010 alone the government recovered over $7 billion in false claims, healthcare and pharmaceuticals made up 75% of total payment. And since then more than $130 million of claims has been settled.

The amount listed is the enrollment agreement was 10,020.00 which gives a difference of :

I am Myrna Montoya, a registered nurse from New Jersey and currently taking the RN-BSN online program at Notre Dame College, South Euclid, Ohio. In our course on Health Care Policy in Complex Adaptive System, the students were given the opportunity to review the 2002 case of Finnerty v. the Board of Registered Nursing. As was ruled by the Court of Appeal, Ellen Hughes Finnerty, a registered nurse, was found guilty of gross negligence and incompetence.

The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtaining money. This is usually conducted through fraudulent activities. This is the nature of white-collar crime. There is no force or violence involved but it is still illegal. (SSA) Obviously, when such a large amount of money is involved there is

Ethical principals are the seed of which nursing flourishes from. Many ethical principals were involved and dishonored in this case such as, justice, autonomy, beneficence, non-maleficence, confidentiality and fidelity (Burkhardt et al., 2014). I believe justice was the main principal involved as the entire ethical predicament was revolved around unjust behavior and treatment of the residents. The residents were treated poorly and given unequal rights as a causation of their illnesses. Autonomy, an essential piece of human rights was also being violated in this ethical dilemma. The residents did not have any choice or independence in their care or how they were being treated. Beneficence and non-maleficence are significant dynamics of this ethical situation, as the health care providers needed to reflect on how they can have the maximum benefit while diminishing possible damage to the residents (Burkhardt et al., 2014). Our actions as nurses should always be beneficent and non maleficent, continuously being kind, compassionate and doing what is in their best interest as well a removing and preventing harm. Confidentiality is a key component of nursing and it was blatantly being violated as the health care