Problem
You are the chief nurse executive at an organization that provides clinic services to Medicare patients; there are seven clinics located in underserved areas. While visiting one of the clinics, you perform a routine audit. You notice that one physician, who has been excluded from the Medicare program due to a prior felony conviction for accepting kickbacks for referrals, has submitted bills for $165,000 for services rendered. You contact the physician and she refers you to her attorney. Her attorney says she thought she was following the law when she submitted bills for services her employee performed. The patients received the services and there have been no reported complaints. The physicians speak three languages fluently, and the patients at this clinic have nothing but praise for his care. You have had a great deal of difficulty locating a qualified physician who is willing to work in this crime-ridden area.
i. What is your first action?
ii. How do you justify this action based on legal and ethical guidelines?
iii. What is your second action?
iv. How you justify this action based on legal and ethical guideline?
v. What is your final action?
vi. How do you justify this action based on legal and ethical guidelines?