Accountability and Liability in Nursing: 5 Focus Areas

Imagine you have been working for a health care organization for an extended period of time. It is clear that you have a wealth of information about the accountability and liability that individuals and organizations should be aware of.

You have been asked to create an informational handout for new employees to inform them of the importance of being an accountable and liable individual in a health care organization.
Select a representative from the health care industry below who will represent the perspective of your paper:

Long-term care manager
Physician’s front office manager
Billing specialist
Create a 1,050-word pamphlet that conveys the following information:
Evaluate accountability and liability implications for individuals and organizations in the health care industry.
Evaluate standards of care and potential liability for health care professionals and organizations.
Evaluate the status of provider rights and responsibilities in the delivery of health care.
Evaluate the state and federal statutory and regulatory enactments relative to patient rights and responsibilities.
Evaluate various forms of health care fraud.
Evaluate civil and criminal penalties associated with fraudulent activities.
Analyze the legal and ethical implications of using technology in the health care industry.
Format your assignment consistent with APA guidelines.
Cite 3 peer-reviewed, scholarly, or similar references.
Click the Assignment Files tab to submit your assignment.

What is Accountability and Liability?

In the healthcare industry, it is the responsibility of each professional to deliver high-quality patient-centered services. More so, practitioners should focus on acting ethically at all times lest they face legal implications specified in their accountability and liability agreements.

For instance, if a nurse gives the wrong medication to a patient, the practitioner is liable for the malpractice. The organization holds such individuals accountable for their actions. Kongstvedt (2012) argues that every healthcare professional ought to familiarize themselves with the health facility’s standards and policies on general conduct and responsible practices to avoid organizational conflict.

Healthcare organizations also have a role to play in ensuring that the delivery system remains accountable. The focus is on the financial status of the health facility. The Finance and Accounting Department ought to present credible and reliable data on all transactions. Such data include revenue collected from cash payments, insurance reimbursements, and donor funds.

Standards of Care and Potential Liability

Every health institution places a high value on the standards of care accorded to patients. Rich, Allen, and Williams (2015) note that high standards enhance the fast recovery of patients. Further, the hospital records fewer patient admission rates.

Also, high standards of care minimize cases of Healthcare-associated Infections (HAIs). Such infections arise from poor medical facility safety measures. For instance, if a surgeon fails to wear protective clothing during operations, there is a risk of infecting the patient with a common communicable disease such as flu. Such unsafe practices endanger the patient as more infections weaken the immune system.

Sub-standard care imposes negative implications upon health care professionals and organizations. First, the practitioner found guilty of unsafe healthcare practices faces the risk of job termination. Second, the professional may be sued for negligence of the facility’s policies on high standards of care. Third and last, the health institution may be shut down.

Provider Rights and Responsibilities

There are several health care provider rights and responsibilities under the U.S Insurance Law sections and Health Law sections. Fundamentally, the law purposes to protect healthcare providers from external disputes with stakeholders.

One of the rights is provider contracts. Under this section, Health Maintenance Organizations (HMOs) and insurers provide detailed financial information regarding payment terms to the contractor cum healthcare provider. The contract’s terms also exempt the provider from any liabilities that might arise from the health plan.

Another right that the provider enjoys is the explanation of reasons for contract termination. The HMOs and insurers have to give satisfactory explanations to the provider, as well as an opportunity for case review or hearing. However, the provider has the responsibility of according quality care to patients, as well as acting ethically. Acts of fraud or legislative action banning the provider from practice can lead to an unceremonious contract termination (Department of Financial Services, n.d.).

State and Federal Statutory and Regulatory Enactments

The government is cautious about the manner in which patient rights and responsibilities are handled. For instance, if a provider causes imminent harm to a patient, the state licensing board might pursue disciplinary action against the perpetrator of the vice.

Such actions include withdrawal of operating license thus rendering the provider incapable of continued healthcare practice. The State and federal authorities enact such strict measures to protect patients from substandard care and discourage irresponsibility on the part of the provider.

The legislative bodies also create provisions for patients which include the right to medical records. Primarily, the health provider is charged with the responsibility of availing a patient’s medical records including health history. The patient has the right to keep such information files private (U.S Department of Health and Human Services (HHS), 2014).

Healthcare Fraud Accountability and Liability

There are several forms of healthcare fraud.  One instance involves billing patients’ insurers for health services that are non-existent. For example, a health provider might include a surgical operation on a patient’s medical claim form while the patient did not undergo surgery.

Another type of fraud entails the provision of unnecessary services with the aim of making big claims to the insurance companies. Further, some health care providers give false diagnosis results to convey the need for unnecessary treatments and medical procedures (National Health Care Anti-Fraud Association, 2016).

For instance, a patient with mild abdominal pain might be subjected to a CT scan. The practitioners might argue that the problem could be due to an internal inflammation or growth that can only be established through a scanning process. Such uncalled-for procedures only call for more costs on the patient or the insurer.

Civil and Criminal Penalties Associated with Fraud

Medical practitioners who engage in fraudulent activities are punishable by law. First, the guilty party may be fined up to three times the value the insurance company has lost. Also, the individual is liable for a sum of $11, 000 for every claim filed. Further, a practitioner who commits fraud is punishable by jail terms and exclusion from participating in health care services (Office of Inspector General, n.d.). The latter means that the healthcare professional is no longer allowed to practice in the federal health sector.

The fraudulent activity limits the practitioner from seeking jobs in the area of public health. Such an individual may also have a hard time if they decide to operate in the private sector. Primarily, the employer might have reservations about employing fraudulent personnel.

Further, the individual may be denied an operating license for opening a private health facility. For example, if a qualified and experienced but corrupt Medical Officer (MO) wishes to open a clinic, dispensary, or pharmacy, the license providers might conduct a job profiling for the individual. Records of work dismissal due to fraud complicate the business permit process.

Legal and Ethical Implications of using Technology in the Health Care Industry

The Electronic Health Information Technology (EHIT) compromises physician-patient confidentiality (Norman, Aikins, & Binka, 2011). The technology gathers crucial patient information which can land in the wrong hands. In essence, sensitive information collected and stored via the cloud platform can easily be intercepted via the Internet.

Further, the EHIT encroaches on a patient’s private health information. Primarily, researchers on longitudinal population data usually use patients’ information to file findings. In most cases, the patient’s consent is not sought. Other technologies such as Electronic Medical Records (EMRs) pose legal threats for physicians. Essentially, insurance firms can review electronic transactions to prove malpractice in claim requests (Cahill, Gilbert, & Armstrong, 2014).

References

Cahill, J. E., Gilbert, M. R., & Armstrong, T. S. (2014). Personal health records as portal to the electronic medical record. Journal of Neuro-oncology, 117(1), 1. doi: 10.1007/s11060-013-1333-x

Department of Financial Services. (n.d.). Health Care Provider Rights and Responsibilities. Retrieved from http://www.dfs.ny.gov/insurance/hprovrght.htm

Kongstvedt, P. R. (2012). Essentials of managed health care. Jones & Bartlett Publishers.

National Health Care Anti-Fraud Association. (2016). What Does Health Care Fraud Look Like?. Retrieved from https://www.nhcaa.org/news/what-does-health-care-fraud-look-like.aspx#

Norman, I. D., Aikins, M. K., & Binka, F. N. (2011). Ethics and electronic health information technology: challenges for evidence-based medicine and the physician-patient relationship. Ghana medical journal, 45(3), 115.

Office of Inspector General. (n.d.). A Roadmap for New Physicians Fraud & Abuse Laws. Retrieved from https://oig.hhs.gov/compliance/physician-education/01laws.asp

Rich, J. D., Allen, S. A., & Williams, B. A. (2015). The need for higher standards in correctional healthcare to improve public health. Journal of general internal medicine, 30(4), 503. doi: 10.1007/s11606-014-3142-0

U.S. Department of Health & Human Services. (2014). What are my health care rights and responsibilities?. Retrieved from https://www.hhs.gov/answers/health-care/what-are-my-health-care-rights/index.html

Read more about Nurse Practice Act and guiding principles.