ethical dilemma in case management?

[illsince83]

what do you inpatient hospital case managers do in regards to who you refer (for SNFs or home health services) for your patients?

[SummerGarden, BSN, MSN, RN]

OP: This post is very cryptic and does not make sense. Please rephrase your question.

[KelRN215, BSN, RN]

I don't understand your question nor do I understand how the question is related to the topic. Whether or not a patient is referred to long term care or home health is based on each individual patient's situation.

[CapeCodMermaid, RN]

I think your headline is very misleading. There is no ethical dilema here.

[dcagle]

Medicare requires that each hospital keeps on hand, a list of Medicare certified providers in which patients are to choose from. There should be a list for Hospice, Home Health, DME, Home IV Infusion, SNF's, etc. Patients/Family/Representative (if applicable) MUST be provided with a list of local providers for the particular service they are in need of, and must choose a provider from the list. CM's are not able to choose for the patients. I have patient's choose 2 or 3 providers in the order of preference, in the event that their #1 or #2 choice(s) cannot accept the patient for service.

Please note that this list is not only for Medicare beneficiaries. All patients requiring post-acute services must be given the CHOICE of their provider. This is due, in part, to the "Anti-Kickback Statute". The OIC (Office Inspector General) has set forth guidelines and believe me, if this is strictly enforced, criminal charges can be brought up as well as hefty fines. We started limiting the amount of marketers that we would see and stopped accepting anything from them accept ink pens! No coffee, lunches, cookies, donuts; Nothing!

Here's a link to the "OIG Supplemental Compliance Program Guidance for Hospitals"for your viewing "pleasure". Hope this helps!

https://oig.hhs.gov/fraud/docs/complianceguidance/012705HospSupplementalGuidance.pdf