How can APNs utilize their scope and responsibilities to protect patients and healthcare facilities from financial healthcare fraud and abuse?

Solution

Fraud is defined as knowingly submitting, or causing to be submitted, false claims or making misrepresentations of a fact to obtain a federal health care payment for which no entitlement would otherwise exist. In today’s health care environment, Medicare and Medicaid fraud is not uncommon. The negative impact of fraud is vast because it diverts resources meant to care for patients in need to the benefit of fraudsters. Fraud increases the overall costs for vital health care services and can potentially be harmful. (“Recommendations to protect patients and health care practices from Medicare and Medicaid fraud,” 2020) ….

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