Plan and Response for a Chief Nursing Officer

Nursing shortage is a global problem facing all health care system and the impact on nursing professional and patient care outcomes cannot be over emphasized. Despite all effort made by the ANA and health care institutions to address the issue of nursing shortage there seems to be no change and the problem still exist hence there is every need to implement a new plan to address the problem of nursing shortage (ANA, 2014). The project plan is aimed at introducing a policy plan that will help in eradicating nursing shortage. This paper will focused on nursing shortage’s impact on nurses, patients and nursing profession, and a proposed project that will focus on eradicating the problem of nursing shortage through the use of mentoring program for high schools and colleges student.

This paper discusses the leadership style of the Chief Nursing Officer (CNO) at HealthSouth Rehabilitation in Toms River, New Jersey. HealthSouth is the nation’s largest inpatient rehabilitation, there are HealthSouth’s in 28 states and one in Puerto Rico. There are inpatient, outpatient, and home health services. The mission statement of HealthSouth involves an advanced degree of rehabilitative care to clients recovering from cerebrovascular accidents, cardiac and pulmonary disorders, spine, and brain injuries and orthopedic disorders (Kosevich, Leinfelder, Sandin, Swift, Taber, Weber, & Finkelstein 2014).

Medicare and Medicaid have cause a great deal of damage to the American society. "Years of scandal have shown the waste, fraud and abuse that is rampant in Medicare and Medicaid." (Fallen Guardians of Justice: How the Supreme Court is

Health care fraud and abuse is a significant contributor to high health care spending, resulting in the wasteful spending of health care dollars. The Federal Bureau of Investigation (FBI) and National Health Care Anti-Fraud Association (NHCAA) estimates that 3 to 10 percent of health care dollars are lost to fraud and abuse (Federal Bureau of Investigation, 2010). Fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to themselves or some other person (Ryan, 2006). Bloomberg reports health care expenditures are rising faster than the rate of inflation and spending in the US has nearly doubled in the last decade and one-half of health care

Medicare and Medicaid fraud has some strengths as well as weaknesses. A strength that comes with healthcare fraud is The Affordable Care Act. This act helps to fight health care fraud, abuse and waste (Department of Human Services, 2014). Many laws have been implemented to help commit those people that have been committing Medicare and Medicaid fraud. Per the Center of Medicare and Medicaid services website “The Affordable Care Act increases the federal sentencing guidelines for health care fraud offenses by 20-50% for crimes that involve more than $1 million in losses, establishes penalties for obstructing a fraud investigation and makes it easier for the government to recapture any funds acquired through fraudulent practices” (Department

According to the Federal Bureau of Investigation (FBI) “health care fraud costs the country an estimated $80 billion dollars a year” ("Health Care Fraud," n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI along with other government, insurance, and public agencies have joined together to combat fraud at every level. New rules in identifying, investigating, and prosecuting fraud before payments are made to medical providers could save billions of

Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.

(Jones and Jing) Though citizens might not see the effects of health care fraud directly, everyone is impacted in one way or another either through increased taxes, high insurance costs, or the inability to afford health care coverage. While we all hear about major frauds in the system, a majority of the frauds are small and usually go through undetected, unreported, or seriously underreported. (Sparrow) These small frauds add up to be a huge problem. There is a large spectrum of frauds in the health-care systems ranging from the theft of a wheelchair, to organized crime groups that steal patient information and bill for phantom services in multimillion-dollar schemes. (Jones and Jing) In many cases, the fraud is minor but all the small scams add up to an enormous loss to the public. For example, the frequent occurrences of forging of a doctor’s signature on a prescription accounts for billions of dollars lost each year. (Jones and Jing) One of the most common crimes involves billing for services that were never performed. This involves a health care provider submitting a false claim to be paid for a patient that was never treated or adding on services to a patient. For example a doctor may obtain names of other people such as a patients spouse or child who are covered by insurance and put in a claim for them as well as the actual patient. (FBI) Another common fraudulent activity involves upcoding of services. This is when a healthcare

Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very

Although Congress has used several anti-fraud measures to protect the federal government health care programs, the False Claims Act of 1986 has become the main weapon that government prosecutors use against perpetrators of health care fraud. Designed to prevent fraud and other abuses in federal government programs, the False Claims Act has been the primary statute the government has used in its fight against health care fraud. However, government prosecutors do not rely on one statute in their prosecution of alleged cases of health care fraud. Instead, they rely on a combination of statutes, but the False Claims Act has emerged as the main statutory weapon.

The aim of this assignment is to critically discuss the nurse’s role in planning care. The case of care is a 60-year-old lady named Mary. The names in this assignment have been changed in order to remain confidentiality in line with the Nursing and midwifery Council (2015). Mary has a son and lives with her husband of 30 years. Mary was diagnosed with type one diabetes mellitus when she was 18 years old. Mary also has a leg ulcer which is effecting many aspects of her life. Although Mary has other health problems I will be mainly focusing on the leg ulcer.

Fraud has many faces and can be found in almost every industry to include Health Care. In all business aspects, there is always the ten percent that finds a way to conduct business the dishonest way and therefore rules, regulations and laws are put into place to keep the honest businesses honest and provide loopholes for those that are conducting business in the gray areas. In the Health Care Reform Law which was signed into law by President Barack Obama in March of 2010, require health care providers to return overpayments by Medicare and Medicaid. In the Act, medical health care providers and suppliers are governed by the stipulations that require them to render repayment from overpayments within 60 days of being identified along with a written explanation of why the overpayment is being returned. When a strong and effective compliance program is in place the rules and regulations of the Health Care Reform law are not a burden on the medical providers.

Errors pervade in our lives whether it is our home, in our workplace, or in our society. The effects of healthcare errors have impacted all our lives either directly or indirectly. Patient safety and quality care are at the core of healthcare system which strongly depends upon nurses. “To achieve goals in patient safety and quality, thereby improve healthcare, nurses must assume the leadership role. Nurses need to ensure that they and other healthcare providers center healthcare on patients and their families. Even though the quality and safety of healthcare is heavily influenced by the complex nature

These crooks are the possible cause of ruining the reputation of the most trusted and appreciated professionals of our society – physicians. Healthcare fraud can be committed in a variety of ways, but three of the most widely used are described below. The first and most widely known, is billing services that were never endured by using general patient information. When giving personal information out, many hand it over to the front desk assistant at the local doctor. These appear to be people are some of the most known to scam the information and bill patient’s payments that never took place. Keep in mind that when handing over information, the handler is a trusted individual with a good reputation. On the other hand, many are scammed for the opposite; otherwise known as “upcoding,” where patients are billed more expensive services that were actually done. In fact, according to USA.gov a new study showed that 7 percent of identity fraud victims this year reported identity thieves stole their health insurance information, rising up from just 3 percent last year (Federal Bureau Investigation, 2010). This includes the latest scam, called “unbundling,” where scammers con bills and bill each step of a procedure as if it were a separate making the individual pay even more money, leaving devastating effects for the victim. All of which have a common goal of making taxpayers, insurance companies, and

An interview was conducted with the Chief Nursing Officer (CNO) at an acute care facility. This discussion revolved around the following: her style of management, style of communication, decision-making skills, technical skills and delegating skills. Before sharing specific responses to each of these, the CNO wanted to clarify that because she was new to the organization and following someone who had been in this position for over 20 years, during the first year and transition phase, there were certain situations in which she was consciously adjusting her leadership style to fit the culture of the organization. She strongly felt over time the staff would adjust and become more familiar with her natural style of leadership and