Home Care Fraud - How to escape.

[erroridiot]

I have never reported an agency to the authorities for fraud, but I have been accused of doing so and have been blacklisted.

I have seen so much horrifying fraud in home health care that I don't want to work in this field any longer. Sad to say, home care turns my stomach. Part of the problem is the amount of QA I have done at a lot of agencies, usually agencies in some kind of trouble. I see it all and it irks me to the point that I can no longer look at it.

I can't seem to escape home care at all as no employer will give me a chance to do something different. Nursing jobs are scarce in this area. I attended an orientation for a contingent position this week with nurses who had driven 1-2 hours or longer to get to the office. Of course, if was just another agency signing up lots of new staff and having very little work to offer anyone.

Any discussion about getting out of home care, handling fraud and handling blacklisting would be appreciated.

[Pennsylvania_RN]

CFitzRN - and others feel free to join in also :) : I have just left a locally owned HHA here in NE Pennsylvania that has a number of different offices and divisions offering differing services (aides, DME, home health nurses and therapists - and, because I was totally lied to, before I took the job, about the amount of driving between patients, the amount of on-call required, and the amount of time necessary to do their documentation process on the computer and also with myriad log-sheets, etc, etc - as well as feeling pressured to downgrade OASIS items so they can get higher reimbursements - I am hoping to get some input from other nurses about what they consider to be highly honest agencies. I do realize that a lot depends on each individual office when you're talking about a national chain, but I'm hoping to get some input so that I can avoid another disaster. I am actually totally open to moving to a different area where my faith-based nursing beliefs will be more in synch with potential employers and co-workers. Any ideas??? Thanks in advance - nurses are The Best!!!

[nursel56]

Sent you a Private Message, Pennsylvania RN.

[erroridiot]

CFitzRN - and others feel free to join in also :) : I have just left a locally owned HHA here in NE Pennsylvania that has a number of different offices and divisions offering differing services (aides, DME, home health nurses and therapists - and, because I was totally lied to, before I took the job, about the amount of driving between patients, the amount of on-call required, and the amount of time necessary to do their documentation process on the computer and also with myriad log-sheets, etc, etc - as well as feeling pressured to downgrade OASIS items so they can get higher reimbursements - I am hoping to get some input from other nurses about what they consider to be highly honest agencies. I do realize that a lot depends on each individual office when you're talking about a national chain, but I'm hoping to get some input so that I can avoid another disaster. I am actually totally open to moving to a different area where my faith-based nursing beliefs will be more in synch with potential employers and co-workers. Any ideas??? Thanks in advance - nurses are The Best!!!

Sometimes you just do not know until you are working there, unless you know someone who is familiar with or works with the agency. You just don't know what lurks inside of the HHA these days.

I can remember a time earlier in my career and before I worked in Home Health that these thoughts of fraud and lying and such didn't concern me so much. Beware of some of the "faith" based agencies out there. Unfortunately, they may have their own form or worship as in the almighty dollar. I've been told during an interview about how ethical an agency is only to find out that their ethic included some very bad practices.

[CFitzRN, ADN]

Yep, what (s)he ^^ said. I just don't think you can know for sure until you're smack in it. Trust your instincts though.

[NRSKarenRN, BSN, RN]

in choosing an employer, non profit organizations are less likely to have pressures regarding reimbursement @ staff level, keeping non-homebound patients on service, up coding,challenging oasis answers (unless conflicts with other assessment data) etc.

home - visiting nurse associations of america started this specialty

as mission-driven, nonprofit organizations dedicated to the health and well-being of all persons in their communities, visiting nurse agencies (vnas) and hospice providers will be the quality and value leaders in providing home healthcare and hospice and related services

examples of healthcare fraud investigations fy2008

stop medicare fraud

[color=#9b5934]

[color=#9b5934]examples of possible medicare fraud:

[color=#9b5934]- a health care provider bills medicare for services you never got.

[color=#9b5934]- a supplier bills medicare for equipment you never got.

[color=#9b5934]- someone uses another person's medicare card to get medical care, supplies, or equipment

[color=#9b5934]- someone bills medicare for home medical equipment after it has been returned.

[color=#9b5934]- a company offers a medicare drug plan that hasn't been approved by medicare.

[color=#9b5934]- a company uses false information to mislead you into joining a medicare plan

[color=#9b5934]the joint doj-hhs medicare fraud strike force is a multi-agency team of federal, state and local investigators designed to combat medicare fraud through the use of medicare data analysis techniques and an increased focus on community policing. strike force teams are operating in seven cities in the united states: miami, los angeles, detroit, houston, brooklyn, tampa and baton rouge.

[color=#9b5934]the joint doj-hhs medicare fraud strike force is a multi-agency team of federal, state and local investigators designed to combat medicare fraud through the use of medicare data analysis techniques and an increased focus on community policing. strike force teams are operating in seven cities in the united states: miami, los angeles, detroit, houston, brooklyn, tampa and baton rouge.

[color=#9b5934]http://stopmedicarefraud.gov/innews/breakingnews.html

national summit on health care fraud

to date, strike force teams have obtained indictments of more than 500 individuals and organizations that collectively have falsely billed the medicare program for more than one billion dollars.

state search http://stopmedicarefraud.gov/innews/index.html

[blissmissrn]

So is it fraud if the client has an able and competent parent in providing their care who is home all day chatting up the nurse and they are recieving 40hr per week in home care for thier child. Plus respite hours. if they are home all day,then why should the taxpayers be paying for this. would love to know of your experiences and your thoughts on the matter.Blissmissrn

[KateRN1]

That sounds like a Medicaid or Medicaid-waiver case, which is not necessarily subject to the same Conditions of Participation that Medicare is--depends on the state.

[ellakate]

Oriented a HH RN from compact state A with temporary license in my state B. Reported that this person did not act like a licensed nurse. Was told her/his license was in good standing with my state.

It was not! It had been suspended in state A over 10 years ago. This was discovered after nurse went to a subsequent agency. My agency did not protect me from working with an unlicensed person.

Same agency, same management -- licensed person reported to be diverting narcotics and causing conflict. I reported him/her and was told that I was falling victim to mob mentality. (Most of the time I disagree with myself. Mob mentality is not a risk.) I told the supervisor that it was on management's head if something happened. I notified them of what I perceived to be a problem, based on past observation of impaired personnel. This person was later arrested for diversion. Arrested!

My agency did not protect me from working with this person, who had already been flagged by previous agencies for this behavior. In two separate situations, I feel that my license was threatened by being exposed to what is effectively, fraud.

Confession: I can't go back to HH. No can do.

[caliotter3]

Not all offices of all agencies are this lax, ellakate, but sometimes we just reach our limit.

[ellakate]

Not all offices of all agencies are this lax, ellakate, but sometimes we just reach our limit.

This I know! However, I was really taken aback at how easily dishonest people can mess with the system.

[caliotter3]

Me too. But I guess that is about the same in many areas. I try to keep myself out of the mix when it comes to this type of behavior. If I witness something, I report it in writing and go on my merry way. If there is evidence that the managers are part of the problem, I start looking for a new job.

[carwin]

Hello All,

I am a new DON at a small HH agency (40 pts). I am in need of a teaching tools source. I would also like a variety of examples of good documentation for visit notes ( RN an PT), OASIS, 60 day summaries.

Thanks