Managed Care Nursing

Category - Overview

A 72-year-old female diagnosed with Stage IV colon cancer is homebound and receiving home healthcare services through Medicare and Medicaid. The nurse manager for the case assigned a registered nurse and CNA to provide weekly assessments and care. The nurse manager informs the CNA that the patient will need double the order amount of typical weekly supplies. She then directs the CNA to store half of the order in the storage closet in the office for general patient emergency needs. She will then take the rest to the 72-year-old patient.

This is an example of:
  1. Appropriate use of resources in order to ensure supplies are on hand for anyone in an emergency
  2. Health care waste
  3. Healthcare abuse
  4. Healthcare fraud
Explanation
Answer: D - The ordering and storing of excess supplies under a patient’s insurance when the patient does not receive the items is considered to be health care fraud.

There may be a sense of waste and abuse as well. The supplies and services ordered for a patient’s care should always be allocated to them.
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