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A Fishy Healthcare Operation?

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by psych.nurse psych.nurse (Member) Member

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I wasn’t sure where to post this question.

I’m a nurse practitioner working primarily with older adults.  In the past year, a new hospice company has begun serving some of my patients.  I’ve been suspicious of their operations for a couple of reasons.  I learned that they are somehow getting names and numbers of patients and calling them to see if they’re interested in hospice care.  One of my patients who received a call from them was not at a point where he needed hospice, yet the company told him about all of the services and equipment they’d give him.  One of the physicians in my group has been firm about using this particular hospice for our patients, in one case arranging for a parent to be admitted even after she told the doctor that she didn’t want to use that hospice.  One of my colleagues has told me that she believes this physician has a financial stake in this hospice company.

I’m upset about what I’ve seen happening and worried that patients may be getting inappropriate care.

What can I do?

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11 Followers; 3,596 Posts; 26,408 Profile Views

Realistically you can pretty much only report them to the relevant regulatory bodies. CMS, your state department of public health/DHS, etc. That is what you should do if you have evidence that they are defrauding public payors and/or unethically recruiting patients who either don't qualify for or aren't interested in their services. The lengths to which you go in order to verify your suspicions are up to you; I would suggest neither looking for trouble, nor ignoring it if it is obvious.

Edited by JKL33

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Nurse SMS has 8 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

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I agree with JKL. All you can do is report it. If there is validity, it may take a while but it WILL come out in the wash.

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NRSKarenRN has 40 years experience as a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

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Submit a Hotline Complaint | Office of Inspector General

What You Need for Your Complaint

Quote

Our investigations are most successful when you provide as much information as possible about the allegation and those involved. The more you tell us, the better chance we have of determining whether an investigation can be pursued. Before you begin, make sure you have the following information available:

Name and contact information of the individual or business related to your complaint. This includes, if available, addresses, telephone numbers, e-mail addresses, etc.

Narrative explaining the nature, scope, time frame and how you came to learn about the activity in question.

The name and contact information of any individual who can help corroborate the information you are reporting.

Supporting evidence in electronic format that can be uploaded with your report. This may include e-mail communications, documents, billing records or photographs.

 

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46 Posts; 1,440 Profile Views

There are really strong anti-kickback rules for reasons like this. 

I used to service as a Psych NP several group homes owned by one Woman. Suddenly I lost many of my patients because they were all going to a new program. Turns out the owner of the group homes partnered/co-owned that program. 

 

 

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