Proactive Legal Defense

As a medical professional, you’ve probably said it to patients a thousand times, “Why didn’t you come in sooner?”

Humans are the “hopeful species.” We tend to hope for the best and only seek skilled help when things have gone obviously and seriously wrong. Partly, we ignore our own best interests because we want to focus on patient care and nursing issues, and partly it’s because the legal ramifications of even simple acts seem outrageously complex and harsh.

Take a look at an excerpt from the Code of Alabama Section 22-1-11:

(a) Any person who, with intent to defraud or deceive, makes, or causes to be made or assists in the preparation of any false statement, representation, or omission of a material fact in any claim or application for any payment, regardless of amount, from the Medicaid Agency, knowing the same to be false; or with intent to defraud or deceive, makes, or causes to be made, or assists in the preparation of any false statement, representation, or omission of a material fact in any claim or application for medical benefits from the Medicaid Agency, knowing the same to be false; shall be guilty of a felony and upon conviction thereof shall be fined not more than ten thousand dollars ($10,000) or imprisoned for not less than one nor more than five years, or both.

The scary part is the guilty of a felony and the not less than one nor more than 5 years. Have you ever been tempted to help a patient who needs a service or medical device by shading the facts – with no gain to yourself?

The Alabama Medicaid Agency’s current list of suspended providers runs to 28 pages in a .pdf document. Of those 28 pages 14 are for suspended nurses. This is just a single example of the legal minefield nurses practice in every working day.