FBI arrests 5 nurses in $9.3 million hospice fraud

  1. 1
    philadelphia inquirer:
    posted: fri, mar. 23, 2012, 12:26 pm

    fbi arrests 5 nurses in $9.3 million hospice fraud

    five nurses who worked for a philadelphia hospice service were arrested by fbi agents today after being indicted for conspiring to defraud medicare of millions of dollars.between 2005 and 2008, patricia mcgill, professional services director at home care hospice and a registered nurse, "allegedly authorized and supervised the admission of inappropriate and ineligible patients for hospice services, resulting in approximately $9.32 million in fraudulent claims," the u.s. attorney's office said....

    ...hch co-owner matthew kolodesh was indicted separately in october. the for-profit business operated on two locations on grant avenue in northeast philadelphia, providing hospice services for patients at homes, nursing homes and hospitals.

    the creation of false documents related to services for about 150 patients was part of the scheme, according to the indictment.

    usdoj report:
    [color=#1122cc]multi-million dollar hospice health care fraud scheme alleged
    ...in february 2007, hch was notified that it was subject to a claims review audit. according to the indictment, in anticipation of this audit mcgill assisted a.p. in reviewing patient charts, sanctioning false documentation by the nursing staff, and authorizing the alteration of charts. in september 2007, hch was notified that it had exceeded its cap for medicare reimbursement and would have to repay $2,625,047 to the government
    program. at that point, a.p. and mcgill directed staff to review patient files and discharge hospice patients. this resulted in a mass discharge of patients.

    in one month, 79 hospice patients were discharged in october 2007 and a total of 128 discharged by january 2008, some of whom had been ineligible for hospice or inappropriately maintained on hospice service in excess of six months. some of the patients discharged were shifted to another hospice business owned by kolodesh. in the spring of 2008, approximately 20% of the discharged patients were placed back on hospice service at hch with mcgill’s knowledge. ...
    Last edit by NRSKarenRN on Mar 25, '12
    lindarn likes this.
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  3. 6 Comments so far...

  4. 2
    Wow...I am speechless...
    lindarn and Jessy_RN like this.
  5. 6
    The only thing that shocks me about this article is that you could get 5 nurses in one place who would lie and cheat to that extent. Nurses are not saints, but we are overall honest and decent.

    A lesson for all of us who witness fraud and keep silent. Telling ourselves we don't know all the loopholes, and what we know is illegal really isn't.
    tewdles, elprup, lindarn, and 3 others like this.
  6. 2
    Quote from nrskarenrn
    i work with nursing documents and when there are discrepancies, i return them to the nurses for correction and/or clarification. however, when i receive the returned documents, some of the staff have entered the "corrections" as if they have always been there. i referred them to our facility policy and the pa state nurse practice act which governs how medical records are to be made and maintained (draw a line through the error, mark "error", initial and date the correction the day you make the correction, and be sure that your legible signature is on the document). but even their nurse manager does not follow policy. when one record was returned because the nurse wrote that she gave neulasta but the patient was ordered and dispensed neupogen verified by the pharmacy, the nurse manager had her "recreate" the document with no indication of any error. this is unacceptable practice and potentially falsification of medical records. i returned the document again and refused to process the encounter for coding and billing. just for the record, the nurse manager holds a msn and multiple nursing certifications. i do not understand how or why these nurses would think this is the proper way to make corrections to nursing documentation. and this is a "magnet" certified institution. i have offered to present an educational inservice, but was told this would not be necessary. yet this practice continues. i will not accept any document that has not been amended according to policy because i will be contributing to falsification.
    elprup and lindarn like this.
  7. 1
    Quote from imintrouble
    The only thing that shocks me about this article is that you could get 5 nurses in one place who would lie and cheat to that extent. Nurses are not saints, but we are overall honest and decent.

    A lesson for all of us who witness fraud and keep silent. Telling ourselves we don't know all the loopholes, and what we know is illegal really isn't.
    This is an excellent point! It is important for nurses in home care and in hospice pay careful attention to the practice of their agencies and be aware of the laws governing that type of care. We can and will be held accountable if we particpate in fraud.

    It is alarming to me, really, the number of HC and Hospice nurses who are so laid back about their documentation, it's accuracy and timeliness.
    lindarn likes this.
  8. 0
    Tewdles

    Your generalization of hospice nurses is mistaken. There are bad apples in every specialty. I am sure even you work with nurses who are "laid back, inaccuate, and untimely with their documentation." Professionalism and oversite in an organization begans with the managment. The failure is not only with the nurse who perpetrated the fraud. Where was the QA nurse who auited the charts or the attending physician who recertified the patients. There are several checks and balances to the hospice hierarchy. So blame should not be on the nurses only. It should have been caught much earlier the entire system failed.
  9. 0
    LVHospiceRN, perhaps you should reconsider what I wrote.


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