Healthcare Risk Management 2014-06-01

Risk managers as whistleblowers: Is it ever the right path to take?

A risk managers allegations of fraud regarding her former employer are raising questions about the ethics of a risk manager becoming a whistleblower. Experts say the risk manager must exhaust all other remedies before reporting malfeasance to regulators.

Risk manager blows whistle on hospital, alleges Medicare fraud

In what is believed to the first case of its kind, a former risk manager has filed a $50 million lawsuit against the health system that employed her and accused it of defrauding Medicare at 14 health centers.

Risk manager claims top execs endorsed Medicare fraud

In her lawsuit against Prime Health System (PHS), risk manager Karin Berntsen claims that she witnessed leaders at Alvarado Hospital in San Diego encouraging Medicare fraud.

No choice but to report fraud, then resign

There are some instances in which healthcare managers must protect themselves, even if means blowing the whistle on your employer, says Josh Hyatt, MHL, CPHRM, senior risk management specialist with NORCAL Mutual Insurance in San Diego.

Monetary reward can cloud ethical decisions

Another complicating factor when a risk manager considers blowing the whistle is the possibility of the risk manager being rewarded for turning in the employer, such as receiving 10% or 25% of the damages in a qui tam case.

Whistleblowing signals failure of the system

Risk managers might find themselves in difficult situations if they think fraud is not being corrected, particularly if they are also the compliance officers at their facilities, notes John Banja, PhD, medical ethicist at the Center for Ethics at Emory University in Atlanta.

EMTALA deficiencies rise, but why?

Recent data from the Centers for Medicare and Medicaid Services (CMS) indicate that violations of the Emergency Medical Treatment and Labor Act (EMTALA) are on the rise. An EMTALA expert suggests there are several reasons:

States say EMTALA doesn’t stop with admission

Complying with the Emergency Treatment and Labor Act (EMTALA) can be hard enough before court rulings give the rule a longer reach. Courts in Kentucky, Ohio, Michigan, and Tennessee have passed laws that make EMTALA applicable even after admission.

Patient sitters found effective in reducing falls

Patient sitters can be effective in reducing falls, and the savings can exceed the cost of the sitters. Hospitals should follow specific guidelines for a sitter program.

Six elements key to patient sitter program

Falls research led by Michelle Feil, MSN, RN, senior patient safety analyst with the Pennsylvania Patient Safety Authority in Harrisburg, found that these six program design elements were associated with successful patient sitter programs:

Sitter inattention still can let falls happen

Even well-designed patient sitter programs cannot prevent every patient fall, but the research by Michelle Feil, MSN, RN, senior patient safety analyst with the Pennsylvania Patient Safety Authority in Harrisburg identified particular shortcomings that are most likely to allow falls.

ACA might raise cost of med mal insurance

The Affordable Care Act (ACA) might prompt increases in medical malpractice liability insurance. Other types of insurance could become more expensive.

Health IT, drug shortages lead Top 10 safety concerns

Patient safety is a top priority for every healthcare organization, but knowing where to direct initiatives can be daunting. To help organizations decide where to focus their efforts, ECRI Institute has compiled its first annual list of the Top 10 Patient Safety Concerns for Healthcare Organizations.

All Children’s Health System to pay $7M for Stark violations

All Childrens Hospital, Pediatric Physician Services (PPS), and All Childrens Health System in St. Petersburg, FL, have settled a whistleblower lawsuit brought under the False Claims Act for $7 million.

Congressmen aim to reduce med mal abuse

Seeking to lower healthcare costs and improve patient care by reducing medical lawsuit abuse and using evidence-based guidelines developed by doctors, medical liability reform legislation is being sponsored by Reps. Ami Bera (D-CA) and Andy Barr (R-KY).