I'm Not Overthinking This, Am I?

[AngelfireRN, MSN, RN, APRN]

Hello, all. Had an instance crop up today, and I would be interested to see what y'all's take is.

Long story short, we have been seeing a husband-wife couple in clinic, she longer than he. About a month ago, the wife brought in a paper and requested that we sign it. She said that it was so their public assistance would not be cut off. Upon inspection, the form stated that Doc's signature certified that this person was disabled. He's not. My OM and I explained to the wife that we could not legally sign the paper.

The next week, she was back. This time, she had a handwritten note requesting a letter from Doc, with detailed instructions on what it should say. She wanted the letter to say that Doc was treating the man for a certain thing (true), and also that he had told the man to file for disability (PATENTLY false).

The file went on the OM's desk for review. The woman came back every day, and called in between times. She was told each time that Doc would have to review the note and decide if he would write the letter. Doc is not the quickest, he moves at hos own pace, and prefers to handle these things personally.

The gentleman in question came in today. As he was being triaged, he bluntly requested that we "light a fire under it" (his visit) since he had to get back to work. OM happened to be in the area and overheard, and she and I had a quick conference and determined that this was in fact the same guy.

During his visit, I asked him about the letter needed. He affirmed that they still needed the letter to keep their public assistance. I asked about the work, he stated that he worked for family, under the table cash pay, and did not claim any of the wages. Yet he still expected Doc to attest to the fact that he'd been unable to work for almost a year.

Now, having not had a great deal of experience in this arena, I'm asking...this would constitute fraud, right?

Also, if I (and the office staff) have concrete knowledge that he is working, yet claiming he isn't to receive assistance, are we obligated to report? If so, to which department? How far can we go without violating HIPAA?

Forgive the length, just really in a quandary.

[sirI, MSN, APRN, NP]

Now, having not had a great deal of experience in this arena, I'm asking...this would constitute fraud, right?

Yes, on both parts. The patient (if he is successful in actually receiving disability benefits and is not eligible) and the physician (should he/she sign off that patient is disabled when he is not. Abuse of the system as well.

Also, if I (and the office staff) have concrete knowledge that he is working, yet claiming he isn't to receive assistance, are we obligated to report? If so, to which department? How far can we go without violating HIPAA?

What is your "concrete knowledge"? The verbal claims of the patient? That is not concrete.

Right now, doesn't look like fraud/abuse has been committed. Yet. Potential for, yes.

Your physician can end this by not signing off. Otherwise, not much you can do.

You cannot take action (report) before this crime is committed (reporting for what might occur).

Looks like right now patient trying to manipulate the system and hoping he gets what he wants.

[AngelfireRN, MSN, RN, APRN]

Thank you, Siri. Very much appreciated.

[traumaRUs, MSN, APRN]

At least in IL, to say that a pt is "disabled" requires way more than just a letter from the doctor.

[AngelfireRN, MSN, RN, APRN]

True here as well. Doc does not do disability determination, and the person has not been examined by DDS. So, in no way COULD we say he was disabled. And we won't.

Thank you, trauma.

[CRF250Xpert]

I'm very certain it's against the law to lie so a patient can commit fruad and sit at home (or at his real illegal under the table job)with his hand out. Maybe call the cops and turn them in? I work my butt off; I'd rather my tax dollar pay his prison upkeep than his welfare. What i have done in the past is refer the pt to the speiclist that deemed the pt "unfit for work". If they have back pain and see ortho, neurosurgery or Pain mgmt - I send them there to get the letter signed - I refuse to sign nonsense stating a living human being is completely incapable of work. Such humans are intubated and sedated - not out in public.

[nursetim, NP]

NO! I love these senerios, my absolute favorites. No kidding, I love telling malingering buckets of cow flop NO, get a job, you are not disabled. I told a paraplegic he was not disabled, that his hands, mouth, and brains still worked and to stop playing the victim. I don't think anyone ever did anything but fawn over him. Never,and this is the one time never should be used, lie or conspire to lie on a medical record. NEVER!

[morte, LPN, LVN]

I thought the reporting angel was refering to was the PRESENT collection of aid......I am not sure about "dropping a dime" on that....

[AngelfireRN, MSN, RN, APRN]

Yes, I had reference to aid already established. As in currently collecting. The letter she requested was so that it would not be terminated.

[NPAlby]

NO! I love these senerios, my absolute favorites. No kidding, I love telling malingering buckets of cow flop NO, get a job, you are not disabled. I told a paraplegic he was not disabled, that his hands, mouth, and brains still worked and to stop playing the victim. I don't think anyone ever did anything but fawn over him. Never,and this is the one time never should be used, lie or conspire to lie on a medical record. NEVER!

I love this!!!! You rock!