Fraudulent visits - yes I brought it up!

Specialties Home Health

Published

I'm a DON at a HHA. I have an LPN who we've caught a few times and has been accused many times of fraudulent visits. She's on probation with the BON for the same thing in the past. Every time I bring it up to my administrator for disciplinary action, she never wants to do anything!! All the people in the office and in the field can't stand her because she's making $150,000/year while they make 50-60 and actually do their visits. My administrator wants proof, but when I give it to her, she says it isn't good enough.

I have started expressing these concerns on her BON quarterly report, but the state simply extended her probation for another year. I even have MD's calling to say that they don't believe the blood sugars she charts. Her patients have really high HG A1C's or she claims they have high blood sugars, gets them on a sliding scale and boosts their visits to tid.

There are several people we know she doesn't see tid. She's very charming and I can't get any of the clients to rat her out. It happened once, but since the patient was psych, it was dismissed. She refers many clients to the agency, which is why I think the administrator doesn't want to get rid of her. She also insists on taking all these patients and has 26 visits/day!! It just isn't possible to do that many. Any ideas on how to "catch" this person? How does your agency handle these types of nurses?

Specializes in retired LTC.

Now I know that I'm watching too much reality TV, but the first thought that came to mind was to hire an independent private investigator to follow her. Unbiased evidence to document her fraudulent visits. I do have a concern - if the agency takes a hit from regulators, would you be safe or would you get caught up in the mess most assuredly to occur

Specializes in Oncology, Med-Surg.

This nurse is on probation for being caught doing the same thing at another agency. Quarterly, I have to file reports as to her compliance with doing her visits. I have to print, sign my name and write down my lisence number. The state did extend her probation based on my reports, but I'm hoping they will pull her license. I am worried about myself having to attest to her actions and am worried about the agency's future. I am afraid all of us will go down if my administrator keeps looking the other way. And no, her 26 visits are not in the same building - she goes north to south and the suburbs of a big city. She can only chart 5 minutes between visits, when there are often 15-20 miles between some of the visits. She has been written up for documenting visits while the patient was in the hospital and for documenting visits being done while she was out of town.

Specializes in ED, CTSurg, IVTeam, Oncology.

One has to realize that if egregious behavior is so egregious that it defies the imagination as to why it is being overlooked, there exists the distinct possibility that the parties tasked with oversight are actually co-conspirators. In other words, don't be surprised if it turns out that the administrator is being given a nice portion of that 150K payoff. You may be dealing with multiple levels of fraud here.

Its hard to prove. I agree there is no way u can see 26 pt/day. Do the patients realize they could lose benefits if they are caught with her.

Who is doing her supervisory visits? In our agency (isn't this standard?), the each LPN must have a sup visit by an RN monthly for each patient they see. Have the RN doing her sup visits look at the pt's glucometer history and see what the recent BGs are, and see if they match up with what she's documenting.

This is really jaw-dropping to me. Our agency is constantly getting audits from our own corporate offices, state, CMS, JCAHO, you name it and they're coming by.

The administrator is wrong about this one, and your license is on the line, plus your agency could be shut down in a minute for Medicare fraud.

If I were you, and the administrator definitely won't act on such blatant fraud, I'd look for another job ASAP.

Look. I know some of you work for straight-up companies, but what's out there now, is ridiculous. You can read lots of "outing" on the home health and hospice. Pharmacy/device reps out of work due to the big downsizing going on naturally respond to ads by these HH/Hospice co.s looking for reps. They, of course are stunned at how sleazy the biz is. And that's with already knowing the sleaze of pharm/device industry!

You just need to understand that home health is big money. Huge money (but not for you the RN). Lots of lay people are getting into home health and hospice. Nobody in that company the OP speaks of is going to be unhappy with this person. As long as she brings in the cash she's golden to them. But should some outside source be able to document fraud her rear is gone, and they will say they had no idea.... but that probably won't happen, there just are not enough people and resources to check all of this out.

I get HH/Hospice inmail practically daily on Linkedin pleading me to please run a brand new startup HH or Hospice "name your price" they all say...

The US Postal Service implemented an "efficiency tool" where the carriers have handheld scanners and a barcode is placed somewhere on the mailbox and they scan it to show what time they delivered the mail. It helps the bosses keep track of who is taking too long, maybe the route needs adjusted, etc. Also, the Postal Inspectors follow the carriers to make sure that they are parking correctly, and doing everything else correctly. That is the cheap way and I think that your employer has every right to evaluate it's employees that way. It would be interesting for the LPN to have to scan each Pt going in and out of the home and document everything on a computer and verified in a way that can't be falsified. It might cost $$$ to go that route though!!!

Good luck!!

I get that this LPN (and others like her) make a lot of money for the HH agency owners, but she's costing all of us in more than just the waste in Medicare dollars. Because of people like this, the rest of us are under the microscope, and our every move and mark on documentation is watched and micromanaged, and it really ****** me off.

The original poster and her administrator could face criminal charges for Medicare fraud, too. Not anything to fool around with.

Specializes in Pedi.
This nurse is on probation for being caught doing the same thing at another agency. Quarterly, I have to file reports as to her compliance with doing her visits. I have to print, sign my name and write down my lisence number. The state did extend her probation based on my reports, but I'm hoping they will pull her license. I am worried about myself having to attest to her actions and am worried about the agency's future. I am afraid all of us will go down if my administrator keeps looking the other way. And no, her 26 visits are not in the same building - she goes north to south and the suburbs of a big city. She can only chart 5 minutes between visits, when there are often 15-20 miles between some of the visits. She has been written up for documenting visits while the patient was in the hospital and for documenting visits being done while she was out of town.

It is not possibly to drive 15-20 miles in 5 minutes. Cripes, it sometimes takes me an hour to drive 8 miles between patients in the city.

Specializes in acute care then Home health.

"Now I know that I'm watching too much reality TV, but the first thought that came to mind was to hire an independent private investigator to follow her."

Or just follow her a** one day. See for yourself.

Specializes in Hospice / Psych / RNAC.

Your her boss right...tag along one day when you know it's going to be a 26 patient day...done.

Specializes in LTC, Hospice, Case Management.
She has been written up for documenting visits while the patient was in the hospital and for documenting visits being done while she was out of town.

That right there should be all the proof you need! That sounds like outright fraud in my book

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