Fraudulent visits - yes I brought it up! - page 4

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... Read More

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    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?
    carolinapooh likes this.

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  2. 1
    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 likes this.
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    I applaud your ability to see the forest through the trees. . .
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    Quote from salvadordolly
    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.
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    Am I the only one shocked by this practice? In all honesty, I have never heard of it. Sad state of affairs!!
  6. 2
    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
    GrnTea and KelRN215 like this.
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    A nurse at my agency was caught doing fraudulent visits, complete with fake vital signs and forged signatures. She ended up losing her license.
    Worky Quirky likes this.
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    You can declare your rights and protection under the "whistle blower act" and report the agency for Medicare Fraud if these visits are paid for by Medicare. I am sure private insurance carriers would also be interested if they are paying for services that are not actually being provided. And like others have said, Medicare Fraud is a federal offense.
    GrnTea likes this.
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    I supervise 70plus nurses doing private duty for children. I have seen my share of fraud. I report it to the state board of nursing, reverse the charges for the hours billed, and terminate the nurse. Period. That is my responsibility as a RN and as a US citizen. If my administrator bucked me, I would be gone. I refuse to put up with fraud. It is very very hard to prove it, there are lots of sleazy people out there. We have had several parents who have made "deals" with nurses to split the check, and sign their notes. One mother actually showed up at my office, complaining the nurse owed her money. Makes me furious. My license is on the line. It sounds like you have more than enough proof, and your administrator is a disgrace. Report it to Medicare, and the state and run.
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    If your agency issues a laptop or tablet for her on-site documentation, (and you certainly should), entries can be electronically timed AND you can have a GPS chip in it to track where it goes. Consider that. You can also buy free-standing very inexpensive GPS-tracking gadgets to attach to, say, staff name pins, which are then downloadable to show where they've been that day and when. They use them around here to track snow plow contractors to verify their billing. Big Brother-ish? You betcha. How much do you want to avoid being called out for Medicare/Medicaid fraud? Do the risk-benefit analysis and I'd go for the tracking.
    besaangel likes this.

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