The licensed practical/vocational nurse (LP/VN) is working at a geriatric physician's office
The LP/VN has heard numerous complaints from older adult clients that the physician has sent bills to their insurance for times they were not at the office for a visit. The LP/VN saw the computer spreadsheet submitting bills to Medicare for services that were not provided because during the same times, the physician was seeing other clients in the office. The nurse wants to act according to the Federal whistleblower law. The nurse's best next action is to:
A) gather sufficient documentation copies which the nurse retained to support allegations before reporting the information to a Federal agency.
B) discuss the numerous complaints about billing (have names and information on paper) and the information found in the spreadsheet (printed out) with the employer.
C) seek legal advice from an attorney regarding the state and Federal whistleblower laws and steps to take to protect herself from any harm.
D) report the Medicare fraud via the Medicare Fraud Hotline and provide all necessary information.
Ans: B
Feedback:
To protect those who report unethical or illegal practices, the federal government and at least 31 states have passed "whistleblower" legislation that protects nurses and others from retaliation by employers. The nurse's best next action is to discuss the numerous complaints from the clients and what was found in the spreadsheet with the employer. After this step, if the issue is not resolved, then ethically and legally the nurse needs to act under the whistleblower law guidelines and in this case Federal since it is potentially Medicare fraud. The nurse next steps include taking the copies of the evidence that the nurse secured in case the employer should try to delete the computer files to make it more difficult for the nurse to report. The nurse should consult with an attorney for legal advice before blowing the whistle, in case of employer retaliation, such as a sudden firing occurs. The nurse then reports the potential fraud via the Medicare Fraud Hotline and the Federal investigators will check out the legitimacy of the claims and work to rectify the situation.
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