Thanks to everyone who responded to my post about fraudulent visits. I was feeling out of my league with this one, as writing the nurse up repeatedly had no effect.
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.
I started doing visits to the homes after my case managers freaked out on me asking them to do this. Found no glucometers at all in three of the homes. One home had no insulin either. Two of the homes had glucometers with blood sugars weekly, when they were scheduled for tid visits.
One home had no nebulizer in it for 6 months, she was scheduled for bid. The patient said she came by once a week to do his BP. He was supposed to have a pill box set-up, all his med bottles dated back to summer of 2012.
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
Activated the GPS on cell phone - traced to shopping mall and casino most days. Activated the GPS on laptop - never left the home.
We had her start "clocking in" over the phone that dials to our computer system. Of course, she couldn't do it for 26 visits. She tried for some. Then I found computer clock=ins that made no sense. She was clocked in 6 minutes apart from homes that were 14 miles apart. She was giving her code to have the CNa's clock her in for the visits.
After I found all this, my administrator agreed to let me terminate her, the CM's and the CNA's involved.
I assigned new nurses to the cases, and they all got the "what are you doing here" routine. Many of the tid cases said the nurse only came once a week and they did their own blood sugars or their family member did them. We had to discharge most of her clients because they didn't need the services at all.
We already lost dialysis clients because of her. I suspect she wasn't doing the visits on them because they kept ending up in the hospital and the MD would report that they were "underdialyzed". One of the clients ratted her out after being threatened to go to a nursing home because this nurse reported her as non-compliant with the dialysis. This client also confirmed her little trips out of town where she still documented all her visits. She also said the nurse gave her a little money to do her own treatment for the weekend.
Some of the clients reports that she gave them extra narcotics or benzos to keep their mouths shut.
Of course there is more, and we reported it all to the state. The timing was perfect because a nearby agency just got shut down by the feds/state for fraud a few days later.