Am I commiting fraud?

[jodyonthefloor]

This weekend a bunch of us CNAs came in and found bundles of papers. When we opened them we found out that they were past charting that had not been done by people on various shifts that had either quit or been fired. The charting went back months and some of the charting we were being asked to do was for unfamiliar shifts and residents.

I was irritated with the extra work but didn't think anything more of it until another aid said that we were commiting fraud. When she said that and I started to think about it I realized that she was probably right. The charting effects the insurance and there was no way for us to know that the information we were charting was correct or not after so long and not even being there those days.

Is what we are being asked to do fraud and can we get in trouble if state finds out? If state does find out would the aids gets in trouble or just the facility? I am worried and haven't done any of the charting since she said this because I don't want to get into legal trouble.

[JustBeachyNurse, LPN]

Simple answer, if you weren't there and didn't do the work how can you accurately chart information/tasks that you neither witnessed nor performed? I think you already know the answer.

[jodyonthefloor]

I know that its not right but what I am more interested in is if I can get in trouble like fines or worse. Also do you have any advice for how we should handle the situation. Should we report this to anybody?

[JustBeachyNurse, LPN]

Risk management or corporate compliance/ethics hotline would be the dept to notify if you dont feel comfortable discussing with your supervisor.

Insurance fraud can get you on the OIG exclusion list and barred from employment from any agency or facility that accepts Medicare/Medicaid. Once on the exclusion list it is very difficult to get off.

Most companies have an ethics or corporate compliance hotline that you can call (anonymously or not) to report or ask for advice. This would be a good place to start. They can also advise you on the legality of the request.

[jodyonthefloor]

Thank you so much. I've been getting really worried ever since the other aid mentioned this to me.

[HouTx, BSN, MSN, EdD]

Simple answer - YES, you are committing fraud. It is a Federal offense. If you are convicted, you can face financial penalties in addition to being put on the OIG exclusion listing. OTOH, If you report it, you may be entitled to a reward if the Feds recover any money that was paid out due to those false claims.

Always trust your gut instinct. In this case, it seems that you definitely knew that something was wrong and have a strong sense of integrity.

[jodyonthefloor]

I'm really glad there is some place on the internet like this was where I can get unbiased advice. I really appreciate the help.

[elkpark]

Yes, as you already suspected, it is fraud. You are responsible even if you were told to do it by your supervisor(s) -- and, rest assured, if the doo-doo hits the fan and it gets found out, your supervisor(s) will deny telling you to do this or even any awareness that this was going on, and do their best to leave you to dangle in the wind and take the hit for the facility.

[wooh, BSN, RN]

I remember being told to do (and doing) the same thing at the end of every month when we'd switch out charting for the month and I'd be told to fill in the empty blanks. When I asked what to do about nights I wasn't even in the facility, or for things that had to be filled out more than once per day, I was told to put the other aide's initials... But it puts you in a tough spot, so I can't advise you on what I'd do if I were you. Yes, it's fraud. You likely won't face any repercussions (except if it got reported, I could see the government trying to come down hard on you to get you to testify against the big fish in the facility, that's what Jack McCoy would do.) It's amazing how many ADLs were completed in the middle of the night back when I was an aide, I was quite the hard worker apparently...