You are a corporate compliance officer for a hospital.  You are also a feature writer for The Medical Reporter, an online health magazine.  The editor asks you to write an 8-10 page feature story about the steps you should take when fraud and abuse cases are reported to a facility. This is very timely as you recently received a call on your “hotline” regarding a potential fraud and abuse issue Ethical and moral components that healthcare providers and healthcare facilities face with fraud and abuse issues.  The caller indicated that Dr. Greedy was billing for services that had not been provided.  You are in danger of losing reimbursement for Medicare and Medicaid programs if this behavior is not stopped.   Your feature should address the ethical and moral components that healthcare providers and healthcare facilities face with fraud and abuse issues.  Your research should include the following aspects:

1. How to conduct an investigation.  It should include the following elements:
   1. Reviewing the initial complaint: What are the items you should look for in a compliant to determine validity?
   2. Notifying the appropriate upper management of the complaint unless they are implicated in the complaint: What are the steps to take to determine who is involved?
   3. Obtaining additional information as necessary and developing a plan for the investigation:  What other items are important to the investigation?
   4. Conducting interviews with staff, residents and/or management: Delineate the types of questions to ask in the interview.
   5. Determining if the allegations are substantiated or unsubstantiated: Identify criteria to determine if substantiated or unsubstantiated.
2. How to develop a correction action plan. The plan may suggest:
   1. A recommendation for a subsequent audit or follow-up to the complaint and determination of when this is necessary.
   2. A recommendation to refund any overpayments to federal government, insurance company or individual payer and when that may be the best course of action.

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By the due date assigned, deliver your assignment to the Submissions Area.

Use the following file naming convention: LastnameFirstInitial_M5_A1.doc.

Assignment 1 Grading CriteriaMaximum PointsDiscussed the process for reviewing the initial healthcare fraud and abuse complaint and the items to look for to determine validity.

-Explained the steps to take to determine who is involved in the complaint.32Discussed how to obtain additional information to develop a plan for the investigation and the items, which would be important to the investigation.-

-Explained how to conduct interviews with staff, residents and/or management and the types of questions to ask in the interview.-

-32Identified the criteria to determine if the allegations are substantiated or unsubstantiated.32Explained how to determine when a recommendation for a subsequent audit or follow-up to the complaint is necessary.

-Discussed the best course of action when a recommendation to refund any overpayments to federal government, insurance company or individual payer is warranted.

-Written Components: Style (8 points): Tone, audience, and word choice Organization(16 points): Introduction, transitions, and conclusion Usage and Mechanics (16 points): Grammar, spelling, and sentence structure APA Elements (24 points): In text citations and references, paraphrasing, and appropriate use of quotations and other elements of style. Ethical and moral components that healthcare providers and healthcare facilities face with fraud and abuse issues

Nervous System and Mental Health

Albert, a seventy-two year old African-American man, is brought into the emergency room by his daughter. Approximately 45 minutes before arriving, Albert dropped his book when his right arm and hand “fell asleep”. When he tried to rise, he noticed his right leg was weak and he needed to hold onto the couch to stand up. He had a difficult time talking because the right side of his face and mouth were “numb” and his tongue felt “thick”.

In obtaining a medical and family history it was noted that Albert has smoked at least 1 pack of cigarettes per day for the last 40 years and both of his parents died of strokes when they were in their mid sixties. He has previously been diagnosed with both essential hypertension and hypercholesterolemia. He admits to “skipping” his anti-hypertensive medication because of the unpleasant side effects it causes. Albert notes that he has been experiencing short (5 – 10 minutes) incidences of weakness on his right side, but he attributed this to the position he was in, causing his arm or leg to “fall asleep”. He has also noticed that he is having mild headaches, but recently, these have been less frequent Nervous System and Mental Health

Physical examination indicated that Albert was alert and anxious, but his speech was slurred. He was afebrile, had a respiratory rate of 16 breaths per minute, a regular heart rate of 86 beats per minute and a blood pressure of 190/120 mm Hg. Albert had no irregular heart sounds and presented with slight bilateral edema of the ankles Nervous System and Mental Health. Examination of the nervous system indicated intact tactile sensory function, decreased strength of the right extremities, a diminished gag reflex, diminished right deep tendon reflexes, and right facial droop. Based on these symptoms the emergency room physician suspected a thrombolytic stroke and immediately ordered a head CT scan and various blood tests. The physician also discussed the relative benefits and risks of various treatments and courses of action with Albert and his daughter. Albert was given aspirin for possible thrombosis and a b-blocking anti-hypertensive and his condition was monitored closely while awaiting the test results.

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Results of the laboratory tests indicated hyperglycemia, hypercholesterolemia, normal blood clotting times and platelet numbers. In addition, the head CT was normal. Despite the treatments initiated, Albert’s condition continued to deteriorate. While his blood pressure decreased to 170/84 mm Hg, his heart rate was elevated to 100 beats per minute and became irregular. He continued to demonstrate decreased sensation on his right side, slight dysarthria, and further decreases in strength in both right extremities. Based on these results, treatment with plasminogen activator was initiated and an electrocardiogram (ECG) was conducted. The results of the ECG indicated atrial flutter.

After 5 hours, Albert’s condition improved to the point that the hemiparesis and dysarthria were at baseline levels and his blood pressure was stabilized at 156/70 mm Hg. Further treatments were then initiated to stabilize Albert’s atrial flutter and hypertension. He was given digoxin, which stabilized the atrial flutter and heart rate at 80 beats per minute and an angiotensin converting enzyme (ACE) inhibitor was prescribed for the hypertension. An echo-cardiogram indicated bilateral stenosis of the carotid arteries. Anti-thrombolytic therapy (325 mg aspirin/day) was also prescribed. Albert was encouraged to stop smoking and to modify his diet and was discharged Nervous System and Mental Health

What symptoms suggested that Albert was having a stroke? What risk factors did Albert present which would support the symptoms observed? Why does Albert’s treatment include aspirin? Nervous System and Mental Health

• Module 8 Vocabulary- Neurological Assessment
• Nursing Journal Article: CE: The Physiology and Processing of Pain: A ReviewAttached Files:
  •  Link to file (212 B)
  • Neurological Article Questions
    1. Pain- both acute and chronic-cost on an annual basis in the U.S. approximately how much?
    2. What is the frequency of pain and visits for pain complaints to physicians at the present time?
    3. More than 2/3’s of persons with chronic pain have had it how long?
    4. What is the International Association for the Study of Pain (IASP) definition of pain?
    5. A nociceptor is defined as…? Neurological Article Assignment
    6. Name the steps for pain perception from the peripheral tissue nociceptive receptor.
    7. Name three different types of non-nociceptive receptors.
    8. Name the two types of fibers found in the spinal cord.
    9. Describe what you would find in both ventral horns and dorsal horns of the spinal cord (hint: see figure 3).

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  • 
    10. What is Lissauer’s tract?
    11. What are the three tracts that transmit nociceptive/pain impulses?
    12. Name six supraspinal structures in the brainstem and diencephalon where the nociceptive signal travels?
    13. What is a major component of pain modulation circuit called?
    14. Control of ascending sensory input by tonic inhibitory control of neurons occur where?
    15. Which area of the medulla of the brain exhibits both inhibitory and facilitation of nociceptive transmission?
    16. How do NSAIDS work to modulate the pain network? Neurological Article Assignment
    
    
• Neurological Article Assignment

Take a few minutes to think about the most pressing health-promotion and disease-prevention issues, such as those identified in “Healthy People 2020” and the Institute of Medicine’s Future of Nursing. Which one most calls your attention? Maternal, infant, and child health? Health communication and health information technology? Immunization and infectious diseases?
 

This course provide a venue for addressing issues such as one of these through the design of a program and associated evaluation. In order to design an effective program though, it is critical to narrow the focus from one of these larger issues to a specific problem and a target population. Identifying a Health Care-Related Problem and a Target Population
  

This Discussion provides a forum through which you and your colleagues may support each other in first selecting a health-promotion and disease-prevention issue of national significance, and then identifying a problem and a target population to guide your program planning and evaluation efforts in this course.
 

To prepare:

 

• Examine      the topics presented in “Healthy People 2020” and the Institute      of Medicine’s Future of Nursing. Select a health-promotion and      disease-prevention issue of national significance that has particular      resonance or appeal for you.
• Review      literature related to the issue you have selected and, specifically, the      problem and target population you may choose to focus on as you move      forward with program planning.
• Review      this week’s course text readings. What questions or concerns, if any, do      you have about how to identify a problem and a target population for      program planning and evaluation?
  
   

Note: For Application 1, you need to identify a health care–related problem and a target population to guide program planning as you move forward in the course. If you have not already done so, read the instructions for Application 1 (provided this week) as your work on this Discussion to guide your development of that assignment. Identifying a Health Care-Related Problem and a Target Population
 

By tomorrow Tuesday 12/04/18 by 6pm, post a minimum of 550 words in APA format with at least 3 references from the list of the “Required Readings” below. Include the level one header as numbered below:

Post a cohesive scholarly response that addresses the following:

 

1) Share the national health-promotion and disease-prevention issue you have selected. Describe the problem and target population you will most likely choose for Application 1, as you have considered it thus far (See the list of topic areas below and select one).

 

2) Provide your evaluation of the impact of the problem on population health using citations from existing literature.

 

3) Pose any questions or concerns you have related to your problem and target population, your literature review, and/or other issues related to designing and evaluating programs. Ask your colleagues for support in addressing these questions or concerns.

Topic Areas (Select one to answer question 1 above [make sure to select the one that would be easy to research and develop as all the many upcoming assignment will be based on it. Choose carefully please]).

The Topic Areas of Healthy People 2020 identify and group objectives of related content, highlighting specific issues and

populations. Each Topic Area is assigned to one or more lead agencies within the federal government that is responsible

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for developing, tracking, monitoring, and periodically reporting on objectives.

1. Access to Health Services

2. Adolescent Health

3. Arthritis, Osteoporosis, and Chronic Back

Conditions

4. Blood Disorders and Blood Safety

5. Cancer

6. Chronic Kidney Disease

7. Dementias, Including Alzheimer’s Disease

8. Diabetes

9. Disability and Health

10. Early and Middle Childhood

11. Educational and Community-Based Programs

12. Environmental Health

13. Family Planning

14. Food Safety

15. Genomics

16. Global Health

17. Healthcare-Associated Infections

18. Health Communication and Health Information

Technology

19. Health-Related Quality of Life and Well-Being

20. Hearing and Other Sensory or Communication

Disorders

21. Heart Disease and Stroke

22. HIV

23. Immunization and Infectious Diseases

24. Injury and Violence Prevention

25. Lesbian, Gay, Bisexual, and Transgender Health

26. Maternal, Infant, and Child Health

27. Medical Product Safety

28. Mental Health and Mental Disorders

29. Nutrition and Weight Status

30. Occupational Safety and Health

31. Older Adults

32. Oral Health

33. Physical Activity

34. Preparedness

35. Public Health Infrastructure

36. Respiratory Diseases

37. Sexually Transmitted Diseases

38. Sleep Health

39. Social Determinants of Health

40. Substance Abuse

41. Tobacco Use

42. Vision

Required Readings

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

• Chapter 2, “Paint a Picture of Your Target Population:      Assessing Assets and Problems” (See      attached file). Identifying a Health Care-Related Problem and a Target Population

This chapter presents valuable information for identifying your target population during program planning. Note: Some of the information in this chapter extends into needs assessment, which will be addressed in Week 4.

Kettner, P. M., Moroney, R. M., & Martin, L. L. (2017). Designing and managing programs: An effectiveness-based approach (5th ed.). Thousand Oaks, CA: Sage.

• Review Chapter 1, “Contemporary Issues in Social      Services Program Planning and Administration” (See attached file).
• Review Chapter 3, “Understanding Social Problems” (See attached file).

Review these chapters as needed to help you identify a health care-related problem for program planning and evaluation. For instance, you may find the problem analysis information on page 13 and pages 38–39 beneficial.

Adams, J. & Kaplow, R. (2013). A sitter reduction program in an acute health care system. Nursing Economics$, 31(2), 83–89.

Pinto, B.M., Waldemore, M., & Rosen, R. (2015). A community-based partnership to promote exercise among cancer survivors: Lessons learned. International Journal Behavioral Medicine, 22, 328–335 doi 10.1007/s12529-014-9395-5 

Tompa, E., deBoer, H., Macdonald, S., Alarngir, H., Koehoorn, M., & Guzman, J. (2016). Stakeholders’ perspectives about and priorities for economic evaluation of health and safety programs in healthcare. Workplace Health and Safety, 64(4), 163–174 DOI: 10.1177/2165079915620201.

Leading Health Indicators. (n.d.). Retrieved March 22, 2017, from https://www.healthypeople.gov/2020/Leading-Health-Indicators 

National Database of Nursing Quality Indicators. (n.d.). Retrieved March 22, 2017, from http://www.pressganey.com/solutions/clinical-quality/nursing-quality 

U.S. Department of Health and Human Services. (2010). Healthy People 2020. (n.d.). Retrieved March 22, 2017, from https://www.healthypeople.gov/sites/default/files/HP2020_brochure_with_LHI_508_FNL.pdf 

IOM Future of Nursing Report. (n.d.). Retrieved March 22, 2017, from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/IOM-Future-of-Nursing-Report-1

Required Media

Laureate Education (Producer). (2011). Design and evaluation of programs and projects [Video file}. Baltimore, MD: Author.

• “Defining a      Population Health Problem” (featuring Dr. Melissa Willmarth, Dr. Debora Dole,      and Dr. Donna Shambley-Ebron)

You may view this course video by clicking the link or on the course DVD, which contains the same content. Once you’ve opened the link, click on the appropriate media piece.

In these videos, Dr. Melissa Willmarth, Dr. Debora Dole, and Dr. Donna Shambley-Ebron provide insights related to defining health care-related problems.

Optional Resources

Algera, M., Francke, A. L., Kerkstra, A., & Van der Zee, J. (2004). Integrative literature reviews and meta-analyses: Home care needs of patients with long-term conditions: Literature review. Journal of Advanced Nursing, 46(4), 417–429.

This article compares literature in the field to determine a profile for people with long-term health care conditions who utilize home care services.

Madden, S. G., Loeb, S. J., & Smith, C. A. (2008). An integrative literature review of lifestyle interventions for the prevention of type II diabetes mellitus. Journal of Clinical Nursing, 17(17), 2243–2256.

This article is an example of an integrative literature review that identifies aspects of nursing programs aimed at prevention of type II diabetes, effectiveness of such programs, and compliance with lifestyle changes after such programs. Identifying a Health Care-Related Problem and a Target Population

Week 1, you analyzed a pre-intervention elementary school asthma database from the perspective of a public health informatician. This week, you will review the data set in more detail and discuss the tools informaticians use. For the asthma data summary, you will use your Excel Spreadsheet and Pivot Table reports. You will then answer the following questions in the form of a 3–4-page summary statement that includes the data as well as an interpretation of the findings. The Pivot Tables need to be embedded in your report to explain the summary results.

What summary results do your pivot tables demonstrate about this grade school population of students? Use the following questions to prepare your paper. Why technologies are so important when managing large databases of public health informatics 

Data Frequency Questions:

Introduction:

Begin with an explanation of the tools of informatics, including spreadsheets, relational database technologies, and integrated statistical packages. Why are these tools and technologies so important when managing large databases of public health informatics? 

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Database Analyses

• Are there more males or females in the survey population?
• Which condition has the highest frequency?
• Which month had the highest number of students with breathing difficulties?
• Which school had the highest frequency of students with bronchitis?
• Which gender has the highest frequency of asthma?
• How many students answered yes to Reactive Airway Disease (RAD)?
• What is the percentage of students with RAD that have been prescribed medication?
• Which zip code has the highest number of students living in it?
• Of that zip code, which condition had the highest frequency?
• How many students answered yes to all four conditions: asthma, RAD, bronchitis, and wheezing?
• Based on all four conditions and zip code, are the conditions evenly distributed among the survey population?
• Does one school have more students in the affected zip codes and with all four conditions than the others do?
• Summary:
• Explain your data analyses results and describe what data quality assurances you applied to ensure your results are accurate.

Submission Details:

• Give reasons and examples in support of your responses. Cite all sources using APA format.
• Submit 3–4-page report in a Word document to the Submissions Area by the due date assigned.
• Name your document SU_PHE6203_W2_A2_LastName_FirstInitial.doc. Why technologies are so important when managing large databases of public health informatics