Documentation altering/tampering...Is this the norm??? - page 2

Hello all...I've been reading a lot of posts recently but havn't seen a topic that addresses my concerns so thought I would start my own. I'm an RN in HH about 14 months after 17 yrs in a hospital... Read More

  1. by   Megan Rowden
    Since you have such a history of home health you should look for a better home health company where patients are priority.
  2. by   HealthyNurse
    Quote from RollerRN
    Hello all...I've been reading a lot of posts recently but havn't seen a topic that addresses my concerns so thought I would start my own.

    I'm an RN in HH about 14 months after 17 yrs in a hospital med-surg floor. My agency uses RNs to do only the Admits, Recerts and Resumps and LVNs do the daily/weekly visits. I received very minimal orientation (2 days in the office reading manuals and then followed a nurse on 2 admits) but feel pretty confident now although I learn something new almost daily. We use Kinsser software for charting via our computers at home.

    My concern is with my Oasis assessments coming back to me for my signature but upon review of them I have noticed many changes that weren't made by me.

    Sometimes it's a Diagnosis (ex: Benign HTN changed to Malignant HTN - I was told that anyone with 2 or more BP meds gets diagnosis of Malignant).
    A lot of times it's Sensory (ex: anyone that wears glasses has Low Vision and can't see medication labels).
    Also frequently changed is the Braden Scale for skin breakdown risk (ex: most everyone winds up being at risk for skin breakdown somehow).
    A biggie is Elimination (ex: urinary incontinence gets checked on everyone! I was told that everyone over 50 has at least stress incontinence and if they deny it, it is only because they are ashamed).
    Another is Neuro (ex: Frequently the box is unchecked for Oriented to Time if I have checked that they are forgetful. I was told that you can't be oriented x 3 if you are forgetful!)
    Nutrition (ex: Every pt is made to be of at least moderate nutrition risk).
    And of course ADLs (ex: every category is typically changed to a higher level/need for assistance.)

    All of the above (and more) is being changed by people in the office that did not visit the patient, are not nurses, and without consulting me and they expect me to just sign it with the changes. When I raised questions about this practice I was told that I had a bad attitude and bad reputation for not wanting my documentation changed. The administrator pulled me aside recently and told me that he is auditing my Oasis especially because after these changes are made, the company is making an additional $500.

    I was under the impression that my job was to complete an accurate and thorough assessment - not worry about how much money each box I am checking is adding or deducting. Having come from a hospital setting where a nurses charting of her assessment is pretty much sacred and can't be changed or altered by anyone, this just doesn't feel right to me.

    So my question is....Is this normal and just an accepted part of the Home Health world?
    Any opinions/advice are greatly appreciated!
    I am a home health surveyor that conducts federal CMS surveys. This is Medicare fraud. I don't understand the posters that replied, "Take it or leave it." It is true that there is rampant Medicare fraud in home health and I see similar situations quite frequently, but that does not make it normal or expected. Legitimate agencies would not conduct business like this. Obviously, they are making the patient have a higher acuity level in order to increase payment and inflate their quality outcomes. There are very clear regulations on how the OASIS assessments are to be conducted and how corrections, including coding, should be handled. Even with coding, it is the clinician that is supposed to determine the diagnoses. A coder can help to select the actual codes since that is such a complex process, but any changes, just as with any other OASIS changes, must be made by the clinician. You are right not to blindly sign these documents. I would suggest that you report your concerns to the Office of the Inspector General and also your state agency responsible for oversight of health care facilities.

    Also, I would be very cautious about taking on the role of being the RN on the case, but not actually visiting the patients except for OASIS assessments. How are you supervising the LPNs? How are you fulfilling the role of the case manager if you're only seeing the patient every 60 days?
  3. by   KountryPrincess
    This does not sound like an ethical agency. I have been in HH for 10+ years with the same agency, and my responses would *never* be changed by anyone, not even my director, without my consent. I am called upon occasionally to defend Oasis answers, but that is normal. This agency is practicing medicare fraud IMO. Turn them in and get out! Also, I agree with the poster that had issue with LVNs being the primary ones seeing the patients. This agency is out to save some money big time! Our agency does not even employ LVNs, that is unheard of to me. To ask RNs to just doc on OASIS stuff and risk their liscense by never otherwise seeing the patient is crazy!!!!
    Last edit by KountryPrincess on Nov 15, '12 : Reason: typos