Case Study: False Claims Act

Alternatively, in an emergency, urgent and acute prescribing circumstances, supplementary prescribing is not suitable because the clinical management plan needed to be agreed in-between Independent Prescriber, Supplementary Prescriber and the patient before prescribing (DOH, 2006). However, Nuttall and Rutt-Howard (2011) argued that for long term conditions, non-medical prescribers are able to make an independent prescribing decision. Additionally, they stated that for long term conditions, patients are typical, predictable and their response to treatment is straightforward. But they also suggested that if a patient is presented with a condition in which they are competent to prescribe, then non-medical prescribers should be confident and competent to treat patient. ). Nuttall and Rutt-Howard (2011) states that nurses, midwives and pharmacists are capable to prescribe independently, but allied health professionals are able to prescribe only as a supplementary prescribing who needs a CMP to be in place for the patient they want to prescribe.

Medicare fraud is a very common occurrence in the United States. However, there are whistleblowers who are working hard to stop Medicare fraud. The vast majority of people who report Medicare fraud are healthcare professionals. This includes people such as ambulance drivers, physicians, nursing home workers, hospice workers and nurses.

HIPPA Breaches A Common Legal Issue in Healthcare When it pertains to patient health information discretion is paramount. Protecting patients from threats that could endanger their rights is essential and the primary reason for safeguarding their personal information is to secure the interest of the individuals who are entrusting the organization with their information. There are however breaches to individuals’ private health information. In the healthcare field one common legal issue is HIPPA and data breaches.

A mogul in both the welfare and healthcare systems, Medicaid has a large margin of financial abuse from both sides of the spectrum; healthcare providers and patients alike, both misuse and abuse Medicaid. “Fraud and abuse in Medicaid cost states billions of dollars every year,

A Bordentown family physician’s license was temporarily suspended for prescribing up to 720 opioid pain pills a month without any physical exams or documentation of a legitimate need for the drugs, according to the Division of Consumer Affairs. The physician, Dr. Moishe Starkman, allegedly prescribed large amounts of Fentanyl, Oxycodone, and similar drugs to five patients over the course of five years. From 2012 to 2017, he wrote them prescriptions without legitimate reasons until he agreed to a suspension of his license until a hearing on the allegations with the state Board of Medical Examiners, according to the New Jersey Attorney General’s press release. “We allege that instead of providing legitimate medical care to his patients, Dr. Starkman simply wrote them prescription after prescription for highly addictive drugs without so much as taking their temperature,” Attorney General Porrino said.

AAS- Medical Office Procedures Week 2 Discussion Judy Potts Explain why pharmaceutical representatives leave samples of expensive medications with physicians. Pharmaceutical representatives, show the physicians the newest drugs on the market, to drum up business for the pharmaceutical companies. The representatives leave samples of the products, In hopes that the doctor will strat prescribing their new name brand products for his patients instead of generic drugs. Also, in some cases, the patients are not financially able to purchase a new drug not knowing if it will help with their disease. The clinic 's management staff will determine whether they will be except the newest medication samples from the representative.

Medication use is potentially dangerous. Polypharmacy is increasing, and makes it harder to keep track of side effects and interactions and of potentially inappropriate drug combinations. “The risk of serious consequences, hospitalization, and death due to medication errors increases with patients’ age and number of medications (Scand J Prim Health Care, 2012)”. For example, the GP is supposed to monitor the patient's regular medication, but does not always do so. Lack of monitoring and keeping track of patients’ medication use is a main cause when a patient is given inappropriate drugs.

Healthcare systems have traditionally been constructed around hierarchical perspectives used to train healthcare professionals (Porter-O’Grady and Malloch, 2007). In such hierarchies, senior physicians are often put at the top with certain power distances between other professionals. This can lead to difficulties in patient management when the patients safety is in question, but the healthcare professional involved may be hesitant to question the physician’s treatment plan or are too intimidated to voice out their opinions. In a study of over 2000 healthcare professionals including nurses and pharmacists, nearly half of the respondents felt pressured into administering a medication for which they had concerns, despite previously questioning the prescriber regarding the safety of the order (Institute for Safe Medication Practices, 2004). This was due to feelings of intimidation by the prescriber and an inability to effectively communicate their concerns.

This is more reason why pharmacist has been the most trusted professionals in the United States. Pharmacists do not benefit from patients when we give recommendations on over the counter medicines. We are the drug experts and we are very accessible; we are responsible for African Americans to recoup our trust as health care

The Health Insurance Portability and Accountability Act (HIPAA) is a vital part of the health care industry’s day to day business. HIPAAs procedures define how healthcare companies receive and handle their clients’ health care information. HIPAA helps to protect the patient’s personal information through confidentiality and security procedures while being transferred, handled or shared with other healthcare providers (Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules, 2013). When a patient’s privacy is not regulated, third parties could buy and sell the information without the patients’ authorization. With HIPAA being in place, it prevents healthcare employees from divulging any patient information they

Pharmacists are in a unique position to help. They have the ability and knowledge to implement programs as part of their daily practice to ensure that patients are adherent to their medications. As the medication experts, pharmacists should lead the way to improving medication adherence and providing optimal patient care. The provisions of this bill do not pose a mandate but where appropriate would require the proration of prescriptions, related cost sharing, and dispensing costs in order to conform the patient to one monthly refill that occurs on the same date each month.

The first way would be to check the 5 rights more than once and very carefully. The right patient determination is essential, and typically two-forms of identification are required. This can include checking the patients identification bracelet, asking the patient to state their name and date of birth, or scanning the barcode on the ID bracelet. The nurse must also confirm any allergies. The nurse must have the knowledge to determine if the drug prescribed is the correct drug, correct dose, correct route, and the correct time.

In some states they can only prescribe when collaborating with a

One of the pharmacist’s main goal is to provide individuals with knowledge about the medication they have been prescribed. If a pharmacist has 100% medical knowledge, I believe that an average person has roughly 5% knowledge regarding medication action, side effects, and contraindications. Most people only know what their

The most common medicare violations are centered around billing and coding as well as documentation requirements established by CMS. If there are any discrepancies with either billing and coding or within a therapist documentation there can be serious legal implications for the therapist and facility. In conjunction with legal proceedings the possibilities of monetary fines and refunding of reimbursements exist, as part of RAC audits that retrospectively audit claims as far back as 3