Law information about Nursing?

  1. Does anyone know some good information sites about what kinds of laws you need to follow, specifically for Washington State? Or rules about billing?

    I know a nurse who is billing an estate for 24x7 specialized medical care that we know she did NOT provide. Is this something that she can get her license taken away for?

    Thanks for any help.
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  2. 5 Comments

  3. by   Renee' Y-Y
    I would begin with your state board of nursing for legal stuff. CMS (...Medicare/Medicaid Services) is the place for billing. If this nurse is billing for services not provided...that is fraud...which is illegal...which she can be prosecuted for and lose her ability to bill Medicare/Medicaid for services in the future...which would essentially make her unhirable for any company who bills Medicare/Medicaid... which is just about everyone. As far as licensure...I'm not sure but I want to say 'yes she can'...although if she can't find a job, that license wouldn't matter anyway...there is a screening process that hospitals have to do that would catch someone like this.
  4. by   Curious23
    Quote from Renee' Y-Y
    I would begin with your state board of nursing for legal stuff. CMS (...Medicare/Medicaid Services) is the place for billing. If this nurse is billing for services not provided...that is fraud...which is illegal...which she can be prosecuted for and lose her ability to bill Medicare/Medicaid for services in the future...which would essentially make her unhirable for any company who bills Medicare/Medicaid... which is just about everyone. As far as licensure...I'm not sure but I want to say 'yes she can'...although if she can't find a job, that license wouldn't matter anyway...there is a screening process that hospitals have to do that would catch someone like this.
    She isn't billing Medicare/Medicaid - my grandmother passed away and this woman is billing the estate for $50/hour for "skilled nursing care" which I thought had to be recommended by a doctor.

    She is billing 17 days, 24 hours a day for a total of 408 hours. She wants $50 / hour. This comes out to $20,400.

    I guess we'll start with the board?

    Grandma had been released from a nursing home and no longer required skilled nursing care, and this person wasn't there with her for this whole seventeen days. On some days she was there for 24 hours but she wasn't awake the whole time or providing very much care, since it wasn't necessary. She would have done things like checking blood sugar levels with a glucose monitor, cooking meals, assisting with bathing once a week and providing companionship.
  5. by   leslie :-D
    i think it would depend under what type of agreement she was hired. if she was hired for around the clock care, then she would have to be physically in the house even if she wasn't providing 'skilled' nursing care 24/7. you might consider a nurse attorney if it comes to that. good luck.

    leslie
  6. by   gypsyatheart
    Quote from Curious23
    She isn't billing Medicare/Medicaid - my grandmother passed away and this woman is billing the estate for $50/hour for "skilled nursing care" which I thought had to be recommended by a doctor.

    She is billing 17 days, 24 hours a day for a total of 408 hours. She wants $50 / hour. This comes out to $20,400.

    I guess we'll start with the board?

    Grandma had been released from a nursing home and no longer required skilled nursing care, and this person wasn't there with her for this whole seventeen days. On some days she was there for 24 hours but she wasn't awake the whole time or providing very much care, since it wasn't necessary. She would have done things like checking blood sugar levels with a glucose monitor, cooking meals, assisting with bathing once a week and providing companionship.
    I agree with Leslie. Plus there is a lot of missing info here. Who hired the nurse? Who made the agreement with her? Is there a signed contract or a verbal agreement? If so, again, who made these agreements? Do you have copies of any of this information? Do you have time documentation? Was she employed through a home health agency or is this nurse an independant contractor?
    My first step would be to get with the person who made the arrangements for/with the nurse. Maybe it was your grandmother, but it seems odd she would have contacted an agency or a nurse all on her own to provide help/care. If so, perhaps she felt she needed this care....?
    Anyway, a lot of unanswered questions. Also, I know several home health nurses, RN's who work in the clients home, sleep there, etc. They do indeed bill by the hour, and $50/hr could be an accurate figure.
  7. by   Havin' A Party!
    Quote from earle58
    ... it would depend under what type of agreement she was hired...
    If the submitted bill was premised on the terms of the contract and the actual services performed, then there's no basis to refute the matter.

    Review the arrangement worked out and obtain proof of the services rendered. If all is in order, then fighting the bill may only net you additional costs (for an attorney and other suit costs).

    Good luck!

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