HSA 515: Health Care Policy, Law and Ethic

As a Chief Nursing Officer, I’m responsible for one of the state’s largest Obstetric Health Care Centers. I just received word of some fraudulent behaviors in the center. To mitigate this type of behaviors I must evaluate how the healthcare Qui Tam affects health care organizations, provide four examples of Qui Tam cases that exist in a variety of health care organizations, Devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals, Recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth, and Devise a plan to protect patient information that complies with all necessary laws. After completing my evaluation on Qui Tam I will be able to provide a proper protocol to handle or prevent future issue and grow awareness on how fraudulent behavior affects the health care center.
Qui Tam is Latin for “he who brings a case on behalf of our lord King, as well as for himself”. Qui Tam allows a private citizen (relator, whistleblower) to bring a lawsuit on behalf of the government, as well as himself, against a defendant who may has knowingly committed fraud or criminal act in which the government was victimized (Showalter, 2012). The private citizen need not have been personally harmed by the defendant’s conduct (Department of the Interior Office of Inspector General, 2010). The government can choose to take over the prosecution, but if the government declines the private citizen can proceed alone.
How Healthcare Qui Tam affects health care organizations.
Healthcare is a multi-billion dollar industry and has attracted those who want to defraud health insurance companies and the government (Showalter, 2012). Based on the healthcare industry monetary value it has become the fertile soil for white –collar crimes that end in criminal convictions and financial penalties (Showalter, 2012). The