Ashley Moody’s Medicaid Fraud Case Study: Essay

Assessment: Fraud and Abuse

The former mental health technician was arrested for physically abusing and injuring a disabled person. According to reports from the investigation, Wilson worked as a mental health technician for Wekiva Springs, a registered hospital that provides care services to elderly patients with behavioural and addiction challenges. Wilson physically assaulted a disabled adult in the patient’s room by hitting him repeatedly with his hand. A staff member heard the patient scream and saw Wilson coming out of the room, clenching his fists, and his knuckles were swollen. After investigating further, the nurse found the disabled patient mourning due to pain with blood spilled on the floor, which indicated that he had suffered severely from the assault. The patient was later transported to a general hospital, where he received treatment for an abrasion and bruised forehead. Further investigations also revealed that Wilson had been caught by the surveillance systems physically beating the patient, which called for his immediate termination. Eventually, the suspect was found guilty of assaulting a patient within the care facility and sentenced to a five-year jail term.

Wilson’s act of assaulting a patient within the facility was a contravention of the Patient Safety and Quality Improvement Act. The legislation was instituted in 2005 to ensure that all patients receiving care services from any healthcare professional are treated with dignity to safeguard their physical and psychological health (Naga, 2020, p. 921). It was instituted to respond to the growing concern about patient safety and requires healthcare professionals to focus their activities on improving the patient’s overall health and promoting their comfort and satisfaction with care. It also encourages reporting and analysis of the issues that arise during the delivery of care services to improve the capacity of the healthcare organization to provide patient safety. Practitioners who contravene the regulation risk job termination and prosecution that may result in serving a jail term of up to 20 years, depending on the harm caused to the patient (Naga, 2020, p. 922). Therefore, Wilson’s act of physically assaulting a patient was a contravention of safety guidelines proposed by the Patient Safety and Quality Improvement Act.

Wilson also contravened the Americans with Disabilities Act. The legislation was established to ensure that the elderly and physically challenged individuals do not experience prejudice or mistreatment due to physical limitations. It prohibits discrimination against physically challenged people in several areas, which include access to state and local government programs and services (Forber-Pratt, 2019, p. 241). The regulation requires practitioners to treat physically challenged patients with dignity and develop interventions that promote their health and welfare in the care setting. Wilson’s act of physically assaulting a physically challenged patient contradicted the provision. Assaulting the patient caused severe health implications that called for his relocation to a general hospital. Such an act also intensified the patient’s emotional deprivation that resulted from his physical limitation. Based on the Americans with Disabilities Act provisions, Wilson risks incurring a fine, imprisonment, or having to compensate the victim for his crime. The state government may also impose a fine and require the healthcare organization to meet a higher standard of accessibility, integrity, and professionalism to avoid similar experiences in the future.

The healthcare organization was responsible for providing information regarding Wilson’s fraudulent actions to the Medicaid Fraud Control Unit. The Florida Attorney General’s Medicaid Fraud Control Unit investigates cases in which care providers intentionally defraud the professional standards outlined by the state’s legislative system. To collect sufficient information regarding the fraudulent activity, the unit requires detailed information from the healthcare institutions regarding how the fraud was conducted. As such, it was important for the investigations unit to maintain communication with the healthcare organization’s management to gather sufficient details regarding Wilson’s misconduct. For example, it was important for the unit to interview the practitioner who heard the patient scream after being assaulted by Wilson to get first-hand information about the incident. It was also crucial for the investigating unit to interact with the healthcare organizations’ security personnel to acquire evidence, such as surveillance footage, that could be used to verify Wilson’s answerability in a court of law.

The court should charge Wilson with two counts of abuse of a physically challenged adult and outline an appropriate punishment. The first count of abuse should include Wilson’s act of engaging in an activity threatening a patient’s safety. While each patient deserves to be treated with dignity, Wilson mistreated his patient and ended up contradicting ethical standards for health workers. His action also caused serious health implications to the patient, which validates Wilson’s job termination and an appropriate court decision to imprison him. The second count of abuse encompasses Wilson’s act of assaulting an unobjectionable person. Since the law prohibits people from engaging in activities that may harm other individuals, either directly or indirectly, Wilson should be charged with a third-degree felony, particularly because his negative actions significantly cost the victim of his health. The court could, therefore, outline a punishment of up to 5 years in prison.

References

Naga, O. I. (2020). Patient Safety and Quality Improvement. In Pediatric Board Study Guide (pp. 921-926). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-21267-4_30

Forber-Pratt, A. J. (2019). (Re) defining disability culture: Perspectives from the Americans with Disabilities Act generation. Culture & Psychology, 25(2), 241-256. https://journals.sagepub.com/doi/abs/10.1177/1354067X18799714