Avoiding charges of fraud and abuse: developing and implementing an effective compliance program.

Area of Science:

• Healthcare law and ethics
• Nursing practice and regulation
• Public health policy

Background:

• The federal government has prioritized investigating healthcare fraud and abuse over the past decade.
• Nurses and skilled nursing organizations are increasingly involved in fraud and abuse cases.
• Understanding the drivers of sanctions against nurses is crucial for regulatory bodies and healthcare organizations.

Purpose of the Study:

• To analyze data on sanctioned nurses to identify common reasons for disciplinary actions.
• To provide insights into the types of misconduct leading to sanctions in the nursing profession.
• To inform strategies for preventing fraud and abuse within nursing practice.

Main Methods:

• Examination of data on sanctioned nurses.
• Data obtained from the Office of the Inspector General (OIG).
• Analysis of sanctioning categories including license violations, drug convictions, and patient neglect.

Main Results:

• Nurses are most frequently sanctioned for license violations.
• Drug convictions represent a significant reason for nurse sanctions.
• Patient neglect is another primary cause for disciplinary actions against nurses.
• The findings highlight specific areas of concern within nursing practice and regulatory oversight.

Conclusions:

• License violations, drug convictions, and patient neglect are the leading causes for sanctions against nurses.
• These findings underscore the importance of robust regulatory oversight and adherence to professional standards.
• Addressing these key areas can help mitigate healthcare fraud and abuse involving nursing professionals.