Last week, my sister Elizabeth was taken to a local hospital (Fort Healthcare) close to her subacute facility to be stabilized for transport back to Mayo Clinic. You might recall from previous blogs that she had been hospitalized for 60 days and discharged to subacute care for the past three weeks. She was weak, in pain and understandably frightened and discouraged. The nurses caring for her were attentive, kind and compassionate. They did several things to help her feel comfortable during the nine hour stay prior to transport including getting her a regular hospital bed rather than the standard ER gurney.
It was evident from the moment we arrived that she was in good hands, both clinically and emotionally. What I observed was how they truly embraced a culture of caring in each encounter with her. This is not always easy especially in a busy ER and since she is such a complex patient. In addition to her care, they always made me feel welcome and a part of the care team. Health care fraud wasn’t as popular as it’s today – the fight against substance abuse was the leading prosecutorial movement before from nowhere; banking and savings loan violations became the middle of attention. Now, fraudulent acts concerning medical treatments are at the uproar and enforcement is trying its possible best in putting a stop to those unethical doings but they have to stay working efficiently to curb health care fraud because it’s the best current source of economic losses and at an equivalent time the best source of economic recovery – which it indirectly means not doing anything about it or taking necessary measures against these illegal acts will result into eating up the government’s revenue but prosecuting it’s very worthwhile. You can contact to HEALTHCARE FRAUD GROUP(firm) for the details about health care fraud lawyer.
Investigations relating to health care fraud activity are reportedly at an all time high, and will continue to flourish with the advent of new working groups, task forces and other fraud-fighting activity that existence depends on the development and investigation of health care fraud cases. Simply put, the investigation of health care fraud consists of proving that the provider engaged in an intentional deception or misrepresentation (of material fact) that resulted, or could have resulted, in an unauthorized payment. Some key facts related to health care fraud investigations:
Complaint Driven: Private, local, state and/or federal agencies are actively involved in the identification and investigation of health care fraud and abuse, which, for the most part, are initiated by complaints received from patients, insurers and others on a health care provider or entity.
Complaint Evaluation: The investigative process starts by the investigator evaluating the information in the complaint to determine if it represents actual misconduct, and then to identify what specific laws, rules, and/or regulations may have been violated. Critical areas to be addressed may include:
oDOCUMENTATION-was the services documented as medically necessary, and completely and accurately documented in the patient’s health care record?
oREGULATORY LAWS & RULES-were the services rendered consistent with the administrative law for the State, including scope of practice, training, supervision and delegation? Additionally, were the services, or the manner in which they were rendered, in violation of prohibited conduct?
oTHIRD PARTY PAYER RULES-were the services rendered consistent with the rules set by the involved third party payer, including those relevant to limitation of services rendered, and those limiting the service provider?
oCODING-were the proper ICD-9 and CPT-4 codes used to identify the condition (s) being treated and the services rendered when seeking reimbursement?
Investigative Plan: The investigator will identify potential witnesses to interview, other needed information, such as patient and insurance claim files that may possess evidence of the misconduct. The successful investigation will result in the collection identify and collect all relevant evidence that would indicate the laws, rules and/or regulations governing health care have been violated, and to identify storytellers who will be able to testify on matters relevant to the identified misconduct. The patient file is the crime scene when investigating health care fraud & abuse.
After a four hour medical transport, we were both exhausted and eager to see her settled in her new room. I was so tired that I could barely keep my eyes open. I just wanted her settled and safely in the hands of competent caregivers. When the transporter brought us up to the unit, we were met by a nurse who gave us the “poster-child-of-great-nursing” welcome. Before we even hit the door of the room, he stopped at the bed and said, “Welcome Elizabeth. We’ve been expecting you and are glad you’re here with us. My name is Chris. You’re going to notice something very special about this unit. We have the best nursing care here and are fully committed to helping you.” The SSDI program provides two types of benefits: health insurance and financial compensation. Go through www.dentonandzachary.com to know more about social security disability insurance attorney.
Wow. Nothing, and I mean nothing, could have been a more welcoming statement at that moment for both Elizabeth and me. To her, his words said, “Welcome. We’ve got this. You’re right where you need to be and we’re going to figure out what’s wrong.” To me, his words said, “You can relax now. We’ll take it from here.” I cannot express to you the relief I felt in hearing his words. Especially since the entire time she was in the subacute facility I felt I had to remain vigilant 24/7. There, the nurses were mechanical, only moderately engaged and lacked critical thinking. Hearing Chris’ words, I all but collapsed in the recliner with relief.
For both patients and family members, compassionate, competent and caring nurses are the back bone of a positive experience. It all starts with a culture that fosters engagement. When nurses are engaged and leadership values the patient experience, the HCAHPS scores take care of themselves. In case of negative experience find support and advice at https://www.itsaboutjustice.law/personal-injury-attorney/.
Having this experience was validating for me on so many levels. It exemplified much of the best practices that are frequently cited in the literature. At the same time it verified that the curriculum I developed for nurses, Nurse/Patient Partnership© is spot-on in helping to engage nurses’ hearts so that they deliver care with empathy, compassion, and focus.