20 Feb Critical Thinking Ethical Issue Exercises
Scenario 1
What should you do based on legal and ethical guidelines?
You are the chief nurse executive at an organization that provides clinic services to Medicare patients. There are seven clinics located in underserved areas. While visiting one of the other clinics, you perform a routine audit. You notice that one physician, who has been excluded from the Medicare program because of a prior felony conviction for accepting kickbacks for referrals, has submitted bills for $165,000 for services rendered. You contact the physician, and she refers you to her attorney. Her attorney says the physician thought she was following the law when she submitted bills for services her nurses performed. The patients received the services, and there have been no reported complaints. The physician speaks three languages fluently, and the patients at this clinic have nothing but praise for her care.
Scenario 2
What should you do based on legal and ethical guidelines?
You are an NP who sees mostly post-head trauma patients and refers many of these patients to physical and occupational services. On one routine follow-up visit, your patient claims that he has not had any of the services you suggested, even though you saw several bills from the consulting provider. You ask for an audit and discover that the owner of the service submitted $1.28 million in claims for occupational therapy services that were not provided. The owner used Medicaid provider numbers of licensed therapists without their consent to bill for the never-performed services. What should you do based on legal and ethical guidelines?
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