corporate compliance

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    Anyone have any experience with reporting medicare fraud? need advice NOW
    Last edit by aub123 on Apr 30, '11 : Reason: want to delete
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  3. 11 Comments so far...

  4. 0
    Just call your BON and fire away. Peace!





    Unless you want to elaborate...
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    your facility, especially if it receives medicare and medicaid payments, should have a compliance officer. if you do not have one, then you should have been oriented to the phone number you can use in case of fraud. if not, that is a big no-no. google medicare and medicaid payment fraud for your state to get in touch with local officials. gl!
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    If fraud is reported, and there is an investigation initiated, is the employee "safe" since they did notify. What do you do in the mean time? Business as usual?
  7. 1
    Quote from aub123
    If fraud is reported, and there is an investigation initiated, is the employee "safe" since they did notify. What do you do in the mean time? Business as usual?

    surely they have a way to report anonymously posted in the workplace??
    michelle126 likes this.
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    Quote from aub123
    If fraud is reported, and there is an investigation initiated, is the employee "safe" since they did notify. What do you do in the mean time? Business as usual?
    Quote from greenfiremajick
    surely they have a way to report anonymously posted in the workplace??

    I think she may be referring to the the fact that she is possibly privy to the knowledge of or either an unwilling participant in fraudulent behavior. Wondering what the impact will be on her upon federal investigation.
  9. 0
    Quote from Old.Timer
    I think she may be referring to the the fact that she is possibly privy to the knowledge of or either an unwilling participant in fraudulent behavior. Wondering what the impact will be on her upon federal investigation.
    You may be correct however, I don't want to assume...Hence the post/suggestion. Tough situation to be in, for sure......
  10. 1
    Quote from aub123
    If fraud is reported, and there is an investigation initiated, is the employee "safe" since they did notify. What do you do in the mean time? Business as usual?
    Google whistleblowing
    mindlor likes this.
  11. 2
    Quote from aub123
    Anyone have any experience with reporting medicare fraud? need advice NOW
    There are some cases where, unfortunately, reporting the issue to the compliance officer may not resolve this issue. In that case, you have several options. One is the report to the federal Office of Inspector General: http://oig.hhs.gov/fraud/hotline/ . They do take anonymous complaints. If your organization is accredited, you should also report it to the accreditating organization (Joint Commission, CHAP, etc.). Finally, you should also report the issue to the State. Every state is different, but it would typically NOT be the board of nursing, as another poster suggested. It will the state agency that accredits or licenses the facility: the Department of Community Health, etc.

    Good luck and let me know if you have any other questions.
    NREMT-P/RN and greenfiremajick like this.
  12. 0
    Whistleblowing laws vary by state. Make sure you don't do anything, like violate confidentiality, which could get you fired or put you on the other side of the law. Good luck and thanks for doing the right thing.


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