Fraudulent visits - yes I brought it up!

Specialties Home Health

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Specializes in critical care, ER,ICU, CVSURG, CCU.

you absolutely do not want to end up on the OIG list behind this behavior !

tara1961

10 Posts

OMG who the hell can do 26 visits per day impossible!!!!!! What agency gives that many????

Specializes in Pediatrics, Emergency, Trauma.

Can't you report this nurse anonymously???

:yes:

CMS is eventually going to review the charts, and everyone involved will be in deep doo-doo...

If visits are being documented and assigned as hourly, we ALL know that us not humanly possible.

SuzieVN

537 Posts

Can't you report this nurse anonymously???

:yes:

CMS is eventually going to review the charts, and everyone involved will be in deep doo-doo...

If visits are being documented and assigned as hourly, we ALL know that us not humanly possible.

It seems to take about two years- then you read about a whopping $4 million dollar fine, and that everyone in the place lost licenses, went to the slammer, etc. In this digital age, it will be found out, sooner or later.

Specializes in Pediatrics, Emergency, Trauma.

SuzieVN, that sounds about correct. I did chart reviews for a CMS contractor for a spell...a lot of the chart reviews were on information about 6-18 months prior; sometimes as soon as 3 months. CMS is really getting on the ball in terms if reviewing charts...a bulk of healthcare waste is based in fraud, whether it be a physician or a practitioner. They are looking at nurses especially in HH...When I worked in HH last year, my agency would send out a "reminder" note on documentation and time keeping; when there were two notes within a month span, I chalked it up to nurses committing fraud in hours worked and/or documentation.

SuzieVN

537 Posts

Hard to believe that in this digital age that those nurses would take such a risk. We're talking not just license gone bye-bye, we're talking relocation to the 'big house', to boot?

SuzieVN

537 Posts

Then again? HHA fraud is a federal crime, and I hear those federal prisons are a bit easier to acclimate to. And some even allow conjugal visits-whether you want one or NOT...if you catch my drift? :)

Specializes in Pediatrics, Emergency, Trauma.

I do SuzieVN, lol...I just don't know why this nurse the OP talks about doesn't get it or see "the big picture"....

SuzieVN

537 Posts

I applaud your ability to see the forest through the trees. . .

Specializes in Cardiac, Neuroscience, Med Surg.
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?

This practice is everywhere not just in nursing. It's all in who you are and who you know. Certain management chooses to look the other way for one employee, and does write ups on excellent employees. Often it's supervision writing people up and then laughing as they do the same things. It's just a part of work-life except for the VNA and Medicare entities mentioned as having stricter standards. That's correct, proof is thrown out because they are protecting certain employees for unknown reasons? Sadly, there is no "catching this person" because favoritism has deliberately put her practices into place. It is disheartening that Doctors are calling with doubts. Fraudulent activity affects everyone. There is limited accountability. Companies do what they want. Bottom line are the numbers of visits, speed, billing and perceived "qualities." You already know the person is charming with people. Many elderly clients don't believe in rocking the boat even if they do look beyond the charm with questionable billing statements. There is no point proving anything, it doesn't matter anymore unless it is the company proving an employee negatively. It should be noted that the things that employee is singled out for are the exact same things being ignored of the 26 visit per day nurse. If you don't stop bringing this up with your Administrator, he/she may decide to make you the next person singled out. I've seen this happen in some form with every employer and have heard colleagues telling about their companies doing this in the past. I totally get the situation as long as you can sleep at night after a days' honest work without vocally worrying about this you will come out ahead in the end.

lovinlife11

138 Posts

Am I the only one shocked by this practice? In all honesty, I have never heard of it. Sad state of affairs!!

wincha

339 Posts

Why wouldn't you assign this LPN a realistic number of visits and no more? Medicare fraud will land her in prison, maybe others who had knowledge and did not report her

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