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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.
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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.
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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.
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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.
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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:
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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.
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The Affordable Care Act (ACA) might prompt increases in medical malpractice liability insurance. Other types of insurance could become more expensive.
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Boston Childrens Hospital was hit with a series of cyber attacks that tried but failed to take down its website, officials told the The Boston Globe.
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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.
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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.
