Legal Issues at a Pediatric Clinic, Free Essay in Healthcare Management

Healthcare practitioners carry out their duties in a complex environment governed by several regulations, laws and standards of practice. As an administrator in the pediatric clinic, I have a role to ensure the delivery of quality healthcare services and making sure that the clinic runs efficiently operationally, legally and professionally. To do this, I should address some issues. First, the pediatric clinic is understaffed. Understaffing strains the existing personnel and the facility leading to poor patient outcomes (Aiken, 2002). This has caused staff to practice beyond their scope of practice to cover the existing shortage. Secondly, I would ensure that the clinic is operating within the confines of the law. Failure to follow the law can cause expensive lawsuits and disciplinary actions (Gilmour, Harrison, Cohen, & Vohra, 2011). The false claims filed by the previous manager to cover its financial shortfalls falls under unlawful acts thus should be discouraged. I choose these two issues because they are the heart of the problems faced by the clinic. They are the key determinants of the existence of the hospital and the quality of services delivered.

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Understaffing can force personnel in a hospital to practice above their scope in order cover the shortfalls (Aiken, 2002). The increased population has led to more patients with no subsequent increase in the number of facilities, staffing or funding. Initially, the clinic served a capacity of 50 patients per day. However, the increase in patient load has seen the hospital attend to 75-90 patients per day. The existing personnel cannot handle the increased number of patients adequately for example; the clinic has a daily nurse to patient ratio of 1: 85. The bad economy has also seen the hospital receive little financial allocation by the government thus cannot employ more staff. These challenges have forced the certified nurse aids to draw blood though they are only licensed to take vitals. The lab technicians also take x-rays since the radiographer is only available once a week. Practicing beyond ones scope is an issue of civil liability as it can cause unintentional harm to the patient prompting lawsuits for compensation (Gilmour, Harrison, Cohen, & Vohra, 2011).

The clinic engaged in financial fraud by getting extra payments from the insurance plans. The administrator and the billing department collaborated in committing fraud by billing patients with insurance plans additional false treatments. Filing a false claim is an issue of criminal liability as it is done knowingly making it subject to punishment upon discovery (Page & Fields, 2011). The False Claims Act covers fraud involving government and insurance funded programs. It allows prosecution of the healthcare provider for presenting fraudulent claim (Page & Fields, 2011). The clinic knowingly billed patients for extra treatments to make up for its financial shortfall. The use of such false records can lead to the closure of the facility and the institution of disciplinary measures against the management (Page & Fields, 2011). Apart from breaking the law, the issue also challenges core ethical principle of honesty and truth since the administrator knowingly added the extra payments.

The problem of staff practicing beyond their scope and the falsification of treatment values to earn more revenue has a strong correlation. They are both authored by the financial hardships encountered by the clinic. Reduced funds deny hospitals an opportunity to employ more qualified staff (Aiken, 2002). Therefore, the existing personnel is forced to perform procedures above their scope. The increased monetary needs are as a result of the increased patient load. It is evident that the available funds could not sustain the clinic. Therefore, to save the clinic, the administrator overcharged patients with insurance plans. Additionally, despite the two issues having potential serious legal consequences, the actions are undertaken with the best interests at heart. He allowed the illegal activities to take place so as to save the clinic from closure which could lead to more suffering to the minority communities it serves.

Since the two issues result from the decreased funding of the clinic, the best solution would be one that increases its financial sustainability. Therefore, the clinic should continually explore additional sources of revenue to enhance its economic viability (Page & Fields, 2011). Third party funders such as charitable organizations should be approached for assistance. The clinic should introduce minimum user fees where patients pay for a small part of their treatment. Backing up budgetary needs with concrete evidence from records can be used to lobby for more funding from the government (Gilmour, Harrison, Cohen, & Vohra, 2011). The clinic should also seek to change the amount reimbursed by the insurance companies to increase the sum of money given. Finally, recovery audit contractors should be used to discover overpayments made by insurers to the clinic to prevent future fraud (Page & Fields, 2011).

In conclusion, the clinic has several challenges. It lacks adequate financing and staffing forcing personnel to carry out procedures beyond their scope of practice to cover the shortage. It has also forced the administrator to engage in fraud in an attempt to protect the hospital from extinction. Therefore, to prevent these legal issues, the hospital should address the cause which is reduced funding. As the administrator, I will consider additional ways to supplement the existing funds. The extra funds should be used to procure additional staff to prevent the strain on the existing ones. Adequate funding will also prevent cases of overcharging patients to cover the deficit in the clinics budget. This will ensure that it operates smoothly within the confines the law and profession

References

Aiken, L. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA, 288(16), 1987. http://dx.doi.org/10.1001/jama.288.16.1987

Page, L. & Fields, R. (2011). 13 Legal Issues for Hospitals and Health Systems. Beckershospitalreview.com. Retrieved 27 April 2016, from http://www.beckershospitalreview.com/hospital-management-administration/13-legal-issues-for-hospitals-and-health-systems.html

http://www.beckershospitalreview.com/hospital-management-administration/13-legal-issues-for-hospitals-and-health-systems.html

Gilmour, J., Harrison, C., Cohen, M., & Vohra, S. (2011). Pediatric Use of Complementary and Alternative Medicine: Legal, Ethical, and Clinical Issues in Decision-Making. PEDIATRICS, 128 (Supplement), 149-154. http://dx.doi.org/10.1542/peds.2010-2720b