Blowing the whistle on healthcare fraud: Should I?


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Abstract

Purpose:The purpose of this article is to explore some of the factors involved when a nurse practitioner (NP) is confronted with a healthcare fraud situation. Ethical concepts and decision-making strategies are provided, as well as practical legal considerations.Data sources:Government Internet Web sites; healthcare management, ethics, and nursing journals.Conclusions:There are many forms of healthcare fraud. Healthcare fraud saps financial resources from the healthcare system and from individuals. The decision to blow the whistle on a colleague or organization is not an easy one and has potential for great discomfort. There are ethical decision-making strategies and practical considerations for the process of whistle-blowing should it become necessary.Implications for practice:NPs may be confronted daily with billing and reimbursement issues. Being prepared to recognize healthcare fraud and knowing the ramifications of whistle-blowing are important tools to have in one’s practice repertoire.

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