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 med-surg floor. My agency... Read More

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    I experienced this with my previous job. I worked for hh company and the DON would go back into my assessments and change my charting for example...

    I had a pt with sudden high HTN and the patient refused the ER on several occasions.

    One day I was sending her refusal thru oasis for the doc to sign and I went back to check on it and the bottom of it requested the doctor change her b/p parameters to call MD if B/p is over 240/140

    I couldnt believe it... I could see doing this if she was a hospice patient but this patient was hh... I called the DON and asked if she added the order and she said she did. So my next question was why didnt you make the order under your sign in. And she said bc she wasnt the nurse on the case and that bc she was the DON she could alter my documentation. I then asked her about a separate pt where I noticed several changes made in my assessment to make the patient sound sicker than what they were.

    I called the state board and asked if this was allowed as my don said it was. The state board said simply - someone may fix your charting by proxy if they are identified as another individual. So, basically if they are using your name and password to correct things such as in the case with my DON it is not legal.

    I called my DON and explained to her what the BON said and she still disagreed so I told her that because I was not comfortable with it and due to possible future law suits or what not that I was resigning effective immediately and I was ready to give report on my patients.

    She blew a gasket but I got out of there.
    colleenk63 likes this.

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    I am just finding all this out about Home Care. I have recently given my 2 week notice without having a job! Although I understand that it is a business, I think some of these private "franchises" that call themselves home care agency's , make the profit the number one thing ABOVE patient care. I have seen numerous changes on my OASIS scores and some of them , yes they are justified but others, outright fraud for a higher reimbursement. Now I know why there was such a high turnover rate and when I was hired there was something I signed that said I would pay back $1000 if I left before 6 months. I am leaving shy of 2 weeks of my 6 month mark. I also found out that the MD that works with them and with alot of their patients let his license lapse! I saw this company "solicit" business. This is not for me, so I am getting out ... Bottom line what's right is right and what's wrong is wrong. I want no part of a company like this.
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    I have been in home health for nearly 20 years, and I have been around the block enough to know that this sort of thing happens in a lot of agencies - but that by no means makes it 'okay' or 'expected'. Nobody is allowed to change one iota of information on an Oasis assessment, including the coding, without collaborating with and obtaining permission from the clinician that performed the Oasis assessment. My job is SPECIFICALLY to review and collaborate with the nurses (or therapists) regarding their assessments, and provide guidance/counsel on the reason certain changes might be necessary. Because coding is an extremely complex undertaking in and of itself, most agencies utilize certified coders to ensure they are not losing revenue due to poor coding, OR, on the flipside, getting into trouble for 'upcoding'. However, nothing should be changed without the assessing clinician's permission. Ever.
    HealthyNurse likes this.
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    Since you have such a history of home health you should look for a better home health company where patients are priority.
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    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?
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    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

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