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Homebound but working?



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Aug 25, 2009 09:00 PM

Homebound but working?

by HHLVN

I have been a home health LVN for well over 10 years and have never seen this before. The agency I am currently with has a bilateral amputee in their late 40's that works at a major chain mall store several days a week and is on service for weekly coaguchecks! When I asked one of the office RN's how can we see this person I was told "they overlook the patient going to work because someone has to drive him to and from". I'm definitely not comfortable with making a visit as I don't want my name anywhere near that chart! Am I correct in my thinking? If so what do I need to do?

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13 Comments
No. 1
from caliotter3
Old Aug 26, 2009, 11:15 AM

Default Re: Homebound but working?
If you don't want to work on that case, then tell them that you do not want to be assigned to that case. Make up an excuse if you have to. Remember, in home health the key word is "flexibility".
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No. 2
from berube
Old Aug 26, 2009, 05:44 PM

Default Re: Homebound but working?
i think first it depends on the payor source, tho i do not agree with it, some payors say the patient does not need to be homebound,,,,also i did not think that labs was considered a skill anymore,,,but it may come down to the payor source.
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No. 3
from HHLVN
Old Aug 26, 2009, 08:15 PM

Default Re: Homebound but working?
Sorry, I forgot to make myself clear! The patient is Medicare! I know most insurances will allow home health if needed and the patient can still go to work. But under MC I have never had nor heard of seeing a patient that is able to go to work, even if they are disabled. Taxing effort doesn't apply for this. If it did we would all be homebound! Luckily I didn't have to see him today, couldn't contact him. But, unless I'm wrong, isn't this fraud? And, no, MC doesn't pay for any type of labs, in or out of the home.
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No. 4
from GrumpyRN63
Old Aug 27, 2009, 01:41 AM

Default Re: Homebound but working?
I think whoever drives him to work should swing him by his lab and have them draw his labs or his md should order him his own INR meter so he could do it himself, we don't do any blooddraws period, wouldn't be an issue for me, but I agree, he's not ( anywhere near) homebound, I wouldn't want to be involved with that case
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No. 5
from centexRN
Old Aug 27, 2009, 04:10 PM

Default Re: Homebound but working?
But, unless I'm wrong, isn't this fraud? And, no, MC doesn't pay for any type of labs, in or out of the home.

Yes, it is fraud.
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No. 6
from berube
Old Aug 28, 2009, 08:03 AM

Default Re: Homebound but working?
i agree, i have read and re-read this post------MEDICARE FRAUD!!!!
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No. 7
from KateRN1
Old Aug 29, 2009, 06:05 PM

Default Re: Homebound but working?
I'd agree with the fraud aspect due to not being homebound, but not with the labs per se. If you have a patient on anticoagulant therapy, your skill should be teaching the patient about the therapy. You also have a three-week window for skilled assesment based on acute changes, assuming that the anticoag therapy is new. If your DoN cannot give you an adequate explanation for "overlooking" the homebound guidelines, then I'd say you should be looking for another company. (Some Medicare HMOs do not require homebound status, only an acute change in condition.)
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No. 8
from HHLVN
Old Aug 29, 2009, 08:16 PM

Default Re: Homebound but working?
Thank you all for your thoughts. The pt's been on service since Feb this year, not an HMO, straight MC. Yes, I agree, it's definitely fraud and I just can't believe how obvious it is! I have already decided to find another agency ASAP. This is just some of the icing on the cake, too much to go into here. Just trying to decide when to notify MC of all the problems with them. Guess I will after I leave.
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No. 9
from caliotter3
Old Aug 29, 2009, 08:20 PM

Default Re: Homebound but working?
Best to do it after you leave. Hopefully by then you will have received positive or neutral references from these people to help you get a new job.
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