Discussion Board Responses Rubric

Legal Issues in Healthcare

Legal Issue 1: Regulation of Substance Abuse Disorder

Although nurses play the role of treating patients, it is important to note that they also become sick and need quality treatment including proper handling by their employers whenever they are sick. Practice regulations related to disciplinary actions towards nurses with substance use disorders (SUDs) helpf the nurses with these diseases to protect their licenses while also engaging in alternative ways of resolving such issues apart from litigation. SUDs affect nurses’ abilities to perform their roles effectively. According to the National Council of State Boards of Nursing (2022a), behaviors associated with SUDs among nurses have negative impacts on both the nurses themselves and patients. Patients usually expect to receive quality and safe care from nurses which they are not able to find due to SUDs. Therefore, it is important to take appropriate actions to keep patients safe and protect them from harm by helping nurses to recover from SUDs instead of withdrawing their licenses.

The action by Boards of Nursing (BONs) to use Alternative to Discipline (ATD) programs against nurses with SUDs is justified because, in this manner, the organization is able to assure the public, patients, and nurses of safety and protection. ATDs promote early intervention, separation of severely affected nurses from the workplace, and the implementation of evidence-based treatment interventions to improve the health of the affected nurses (National Council of State Boards of Nursing, 2022b). Healthcare organizations, with the support of state boards of nursing, should work in collaboration to keep patients safe and support nurses with SUDs through their recovery journey through the use of ATDs. Nurses with SUDs, nursing professional organizations, and the Office of Nursing Workforce are indeed key stakeholders involved in the implementation of ATDs aimed at improving the health and well-being of nurses with SUDs.

References

National Council of State Boards of Nursing (2022a). Substance use disorder in nursing. https://www.ncsbn.org/substance-use-in-nursing.htm

National Council of State Boards of Nursing (2022b). Alternative to discipline programs for substance use disorder. https://www.ncsbn.org/alternative-to-discipline.htm

Legal Issue 2: Telehealth Usage: Ethical and Legal Issues

Technological advancements in health care such as the use of telehealth have not only transformed healthcare delivery processes but have also caused ethical and legal issues that need the attention of a contemporary nurse. A positive provider-patient relationship is associated with positive patient outcomes across settings. However, maintaining a meaningful provider-patient relationship has raised ethical concerns among professionals and patients. Some states such as Maryland allow the use of electronic technology to enhance patient evaluation remotely before prescribing medications. However, others like Arkansas prohibit the use of telehealth technology to conduct patient examination and recommends face-to-face meeting before a doctor can prescribe medications to a patient. According to Gajarawala and Pelkowski (2021), telehealth encourages the provision of controversial medical services which is a threat to patient safety. It is recommended that the appropriateness of telehealth should be evaluated based on its associated benefits and risks considering the health needs of contemporary populations.

The rapid use of telehealth has changed the way patient data is handled and this has caused patient privacy and confidentiality concerns. According to Naik et al. (2021), patient privacy and data confidentiality are among the legal concerns that have been raised from the increased usage of telehealth in healthcare settings. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides guidelines for organizations to maximize privacy and confidentiality with data that is collected electronically (Office for Civil Rights, n.d.). Some healthcare providers are unable to adhere to these rules due to a lack of training on how to implement them. Therefore, to enhance the adoption of telehealth, healthcare organization should train their employees on how to implement relevant privacy and confidentiality rules (Naik et al., 2021). As nurses, we need to advocate for the development of policies that will enhance telehealth integration.

References

Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The Journal for Nurse Practitioners: JNP, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013

Office for Civil Rights. (n.d.). Summary of the HIPAA privacy rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html#:~:text=The%20Privacy%20Rule%20protects%20all,health%20information%20(PHI).%22

Naik, N., Ibrahim, S., Sircar, S., Patil, V., Hameed, B., Rai, B. P., Chłosta, P., & Somani, B. K. (2021). Attitudes and perceptions of outpatients towards adoption of telemedicine in healthcare during COVID-19 pandemic. Irish Journal of Medical Science, 1–8. Advance online publication. https://doi.org/10.1007/s11845-021-02729-6

Legal Issue 3: False Claims Act

Cases of healthcare fraud are associated with negative financial impacts for healthcare organizations and patients. As the United States continues to encourage its population to enroll in various health insurance programs, it also needs to enact laws and policies to protect insurance beneficiaries from healthcare fraud (Chen et al., 2020). The False Claims Act serves the purpose of preventing healthcare fraud by helping the federal government to recover money that was sent to entities that filed false claims for services not rendered. As nurses continue to provide quality health care to patients, they also need to understand the types of fraud that are protected by the False Claims Act.

Some Medicare and Medicaid fraud are more common than others. One of the fraud types that are commonly reported in today’s healthcare settings is double billing for a healthcare service not required by a patient at a particular time. According to Chen et al. (2020), a provider can deliberately bill a particular medical service multiple times even at a time when it has not been provided to a patient. Similarly, he or she can bill for services not provided. When such fraud is noticed, the federal government is guided by the provision outlined in the False Claims Act to recover its money. Another type of fraud that is usually reported in healthcare organizations is due to improper coding and upcoding. In this fraud type, a provider might bill for services charged at a higher cost than the services offered to patients (Adashi & Cohen, 2022). To avoid litigation in relation to the provisions of the False Claims Act, today’s nurses should adhere to the billing laws and policies as documented by their states and employers.

References

Adashi, E. Y. & Cohen, I. G. (2022). Health care fraud: The Leading violation of the False Claims Act. American Journal of Medicine, S0002-9343(22)00046-8. doi: 10.1016/j.amjmed.2021.12.014.

Chen, Z. X., Hohmann, L., Banjara, B., Zhao, Y., Diggs, K., & Westrick, S. C. (2020). Recommendations to protect patients and health care practices from Medicare and Medicaid fraud. Journal of the American Pharmacists Association: JAPhA, 60(6), e60–e65. https://doi.org/10.1016/j.japh.2020.05.011